Prevalence Of Inadequate Intake Research Articles

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.

Spatial Distribution and Temporal Trends of Dietary Niacin Intake in Chinese Residents ≥ 5 Years of Age between 1991 and 2018.

Limited knowledge exists on trends in niacin consumption and the prevalence of inadequate intakes in China. Understanding trends and the spatial distribution of the prevalence of inadequate niacin intake is crucial to identifying high-risk areas and sub-populations. The dietary intakes of niacin between 1991 and 2018 were analyzed using the China Health and Nutrition Survey (CHNS) data. The estimated average requirement cut point was applied to estimate inadequacy. The geographic information system's ordinary kriging method was used to estimate the spatial distribution of the prevalence of inadequate niacin intakes. However, between 1991 and 2018, the prevalence of inadequate niacin intake increased from 13.00% to 28.40% in females and from 17.75% to 29.46% in males. Additionally, the geographically significant clusters of high and low prevalence were identified and remained stable over almost three decades. The high prevalence of insufficient niacin intake was more pronounced in Henan and Shandong over 27 years. Further, effective and tailored nutrition interventions are required to address inadequate niacin intake in China.

Prevalence of Inadequate Vitamin D Intake and Status, and Determining Factors for Serum Vitamin D Deficiency

ObjectivesTo estimate the prevalence of inadequate vitamin D intake and status among residents in the urban area of Sao Paulo municipality, Brazil, and to verify the factors associated with this status.MethodsData from 288 individuals ≥19 years old were obtained from the cross-sectional study 2015 Health Survey of Sao Paulo with a focus on Nutrition (ISA-Nutrition), a cross-sectional study. Serum vitamin D levels (25(OH)D3) were assessed by chemiluminescent immunoassay (Diasorin kit, Stillwater, MN, USA). Dietary intake including supplements use was measured using two 24-h dietary recalls. The prevalence of inadequate intake was estimated according to National Center Institute method. The receiver operating characteristic curve was estimated to assess the intake information performance on serum status. Associations between serum vitamin D status and sociodemographic and lifestyle factors were analyzed using logistic regression.ResultsThere was observed a high prevalence of inadequate dietary vitamin D intake in the population (male: 87.5–99.4%; female: 92.4–99.8%). Women were more susceptible to deficient serum status than men (male: 59.4–89.0%; female: 83.0–93.8%), and higher prevalence of vitamin D deficiency occurred during the winter (male: 86.9–100.0%; female: 91.4–100.0%). Vitamin D intake had inefficient performance in correctly identifying individuals with serum deficiency (area under curve < 0.50), except among individuals 19–30 years old. Individuals with sufficient leisure physical activity had 57% lower risk to have serum vitamin D deficiency (p = 0.032).ConclusionsThere was a high prevalence of inadequate status and intake of vitamin D among residents of Sao Paulo, Brazil. Findings indicate that the dietary intake was not a good parameter to assess the serum vitamin D status, and the practice of sufficient leisure physical activity showed to be a protective factor to serum vitamin D deficiency, probably due to greater sun exposure.Funding SourcesSão Paulo Municipal Health Department, FAPESP, CNPq.

Decreased Vitamin C Intake from Food and Supplements in the US Pregnant and Non-Pregnant Population: From NHANES 1999–2018

ObjectivesTo examine how vitamin C intake among women of reproductive age changed from 1999 to 2018 using data from 10 cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999–2000 to 2017–2018.MethodsUsual vitamin C intake and prevalence of inadequate intake were estimated among pregnant and non-pregnant women 20–44 y who participated in NHANES 1999–2018 (n = 11,129), using the National Cancer Institute Method. Covariates included dietary recall sequence, intake day of the week, and dietary supplement use. Regression models were used to test for trends in vitamin c intake from foods, supplements, foods and supplements combined, and prevalence of inadequate vitamin C intake over 10 cycles of NHANES.Results1,392 were pregnant at the time of the exam. Vitamin C intake from foods alone in pregnant women decreased from 125 ± 6.7 mg in 1999–2000 to 103 ± 5.3 mg in 2017–2018 (p for trend = .0003). Supplemental vitamin c intake among pregnant women decreased from 140 ± 2.8 mg in 1999–2000 to 56 ± 0.9 mg in 2009–2010, followed by an apparent plateau between 2011–2018 (p for trend = .02). Consequently, intake foods and supplements combined decreased from 265 ± 31.9 mg in 1999–2000 to 158 ± 16.7 mg in 2017–2018 (p for trend = .0001). Inadequate intake (% < EAR) increased from 10.5 ± 2.2% in 2001–2002 to 17.2 ± 3.1% in 2017–2018 (p for trend = .015). Vitamin C intake from foods alone in non-pregnant women (n = 9,737) decreased from 84 ± 3.9 mg in 1999–2000 to 71 ± 2.5 mg in 2017–2018 (p for trend < .0001). Supplemental vitamin C intake among non-pregnant women decreased from 101 ± 1.3 mg in 1999–2000 to 41 ± 0.5 mg in 2009–2010 followed by an increase to 86 ± 2.7 mg in 2017–2018 (p for trend = .0075). Consequently, intake from foods and supplements combined decreased from 186 ± 15.4 mg in 1999–2000 to 119 ± 5.9 mg in 2009–2010 followed by an increase to 157 ± 28.4 mg in 2017–2018 (p for trend = .0045). Inadequate intake increased from 27.5 ± 2.5% in 1999–2000 to 38.6 ± 2.4% in 2017–2018 (p for trend < .0001).ConclusionsOver the past 2 decades, decreases in vitamin C intake from foods has outpaced the more recent increases in supplemental vitamin C intake among women 20–44 y. Pregnant women's vitamin C intake from both foods and supplements decreased during this time, which may result in an increased risk of infections, premature birth, and eclampsia.Funding SourcesFunded by the Reckitt|Mead Johnson Nutrition.

Calcium deficiency worldwide: prevalence of inadequate intakes and associated health outcomes.

Dietary calcium deficiency is considered to be widespread globally, with published estimates suggesting that approximately half of the world's population has inadequate access to dietary calcium. Calcium is essential for bone health, but inadequate intakes have also been linked to other health outcomes, including pregnancy complications, cancers, and cardiovascular disease. Populations in low‐ and middle‐income countries (LMICs) are at greatest risk of low calcium intakes, although many individuals in high‐income countries (HICs) also do not meet recommendations. Paradoxically, many LMICs with lower calcium intakes show lower rates of osteoporotic fracture as compared with HICs, though data are sparse. Calcium intake recommendations vary across agencies and may need to be customized based on other dietary factors, health‐related behaviors, or the risk of calcium‐related health outcomes. The lack of standard methods to assess the calcium status of an individual or population has challenged efforts to estimate the prevalence of calcium deficiency and the global burden of related adverse health consequences. This paper aims to consolidate available evidence related to the global prevalence of inadequate calcium intakes and associated health outcomes, with the goal of providing a foundation for developing policies and population‐level interventions to safely improve calcium intake and status where necessary.

Micronutrient intakes in a nationally representative sample of teenagers (13–18 years) in Ireland: prevalence of inadequate intakes and risk of excess

Micronutrient intakes in a nationally representative sample of teenagers (13–18 years) in Ireland: prevalence of inadequate intakes and risk of excess

Selecting Micronutrient Intervention Programs to Save Lives: Evidence From Cameroon

ObjectivesWe use the Micronutrient Intervention Modeling (MINIMOD) tool to identify and compare economically optimal sets of micronutrient (MN) programs that focus on two objectives: increasing the number of individuals achieving adequate intake of specific life-saving MNs, and saving children’s lives using sets of MNs. MethodsWe used 24-hour dietary intake data from Cameroon to estimate usual intake of zinc and vitamin A for children 1–5 y (n = 872) and of folate for women of reproductive age (WRA) (n = 902), as well as the prevalence of inadequate intake (below the Estimated Average Requirement) for each. We simulated the effects on inadequate MN intake of single or combined fortification of wheat flour, oil, and/or bouillon cubes, as well as two delivery platforms for vitamin A supplementation (VAS). The Lives Saved Tool (LiST) was used to estimate the number of lives saved by each program, and by all combinations of them. We estimated program costs for each scenario, nationally and subnationally, over a 10-year planning time horizon. The economic optimization model was run twice to identify the most cost-effective combination of programs based on two objectivesachieving adequate intake for each MN, and increasing lives saved by all MNs. ResultsWhen the policy focus is on adequate intake of specific life-saving MNs, the following national and subnational programs are most cost-effective: wheat flour fortified with zinc (95 ppm, at target level), edible oils (9 mg/kg, 75% of target) and bouillon cubes (80 ppm) both fortified with vitamin A, and VAS provided to children in the northern part of Cameroon via Child Health Days. For meeting the folate needs of WRA, wheat flour fortified with folic acid (5 mg/kg, 33% of standard) is the most cost-effective option. When the primary focus is saving lives, a very similar set of economically optimal programs emerges, which saves over 26,000 lives over 10 years. ConclusionsPolicymakers in Cameroon who promote mortality-reducing MN programs using adequate intake and economic efficiency as their guides can expect to save child lives in a cost-effective way. Funding SourcesThis work was funded by a grant from the Bill & Melinda Gates Foundation to the UC Davis, and by a gift from Mars Inc. to UC Davis to support interdisciplinary research and training in economics and nutrition.

Study of Cardiovascular Risk Factors in Adolescents: Association between Intake of Vitamins A and E and Lipid Profile

Background: The diet of Brazilian adolescents is characterized by high intake of fats and sugars and low consumption of antioxidant micronutrients, particularly vitamins A and E. In addition to dietary inadequacies, a significant number of these adolescents present changes in plasma lipoproteins, which may be caused by environmental and lifestyle factors. Objective: To investigate the association between inadequate intake of vitamins A and E and changes in plasma lipoprotein concentrations in Brazilian adolescents. Methods: Cross-sectional, descriptive, multicenter, school-based, nationwide study with 37,023 Brazilian adolescents aged 12 to 17 years were included. Data on sociodemographic characteristics, vitamin A and E intake, and lipid and anthropometric profile were collected. The Student’s t-test was used to compare means and a logistic regression to verify associations; analyses were conducted in the STATA software version 14.0. The study was approved by the Ethics Committees of the participating institutions and all participants signed an Assent Form. Results: The average vitamin A intake was higher among boys, but consumption below recommendation was found in both sexes. Inadequate intake of vitamins A and E was associated with a higher risk of low HDL-c levels in male and public school adolescents. Low vitamin E intake was associated with a higher risk of hypercholesterolemia and hypertriglyceridemia in Brazilian adolescents. Conclusion: This study showed a high prevalence of inadequate intake of vitamins A and E among Brazilian adolescents and data suggesting associations between low intake of these micronutrients and changes in plasma lipoprotein concentrations in this public.

Vitamin A intake in school-aged children in Draa-Tafilalet oasis regions, southeastern of Morocco

Vitamin A has several important functions such as preventing childhood blindness and strengthening the immune system against common diseases in children. The purpose of the present work was to assess the nutritional intake of vitamin A in oasis school-age children. A cross-sectional survey was carried out among children enrolled in public primary education establishments. 4244 school-aged children were randomly selected to take part in the study. Data on dietary vitamin A intake was assessed by the 24-hour dietary recall. Socio-economic characteristics were got using an appropriate questionnaire. Over the entire sample, the median vitamin A intake was around 409.3 μg for girls and 294.5 μg for boys. The prevalence of insufficient vitamin A intake was observed in 58.3%. The prevalence of inadequate intake according to socio-demographic and economic characteristics shows girls tend to develop vitamin A deficiency compared to boys. Children from urban areas show significant percentages of inadequacy. School-aged children with illiterate parents with low monthly income were identified as at risk of having insufficient dietary intake of vitamin A. In conclusion, we have revealed an important level of inadequacy for vitamin A in the overall processed results that must be considered.

Association of maternal diet, micronutrient status, and milk volume with milk micronutrient concentrations in Indonesian mothers at 2 and 5 months postpartum

ABSTRACTBackgroundMaternal micronutrient deficits during preconception and pregnancy may persist during lactation and compromise human milk composition.ObjectiveWe measured micronutrient concentrations in human milk and investigated their association with maternal micronutrient intakes, status, and milk volume.MethodsInfant milk intake (measured via a deuterium dose-to-mother technique), milk micronutrient and fat concentrations, and maternal micronutrient intakes were assessed at 2 and 5 mo postpartum in 212 Indonesian lactating mother–infant pairs. Maternal hemoglobin, ferritin, transferrin receptors, retinol binding protein (RBP), zinc, selenium, and vitamin B-12 were measured at 5 mo (n = 163). Multivariate or mixed effects regression examined associations of milk micronutrient concentrations with maternal micronutrient intakes, status, and milk volume.ResultsPrevalence of anemia (15%), and iron (15% based on body iron), selenium (2.5%), and vitamin B-12 deficiency (0%) were low compared with deficiencies of zinc (60%) and vitamin A (34%). The prevalence of inadequate intakes was >50% for 7 micronutrients at 2 and 5 mo. Median milk concentrations for most micronutrients were below reference values, and nearly all declined between 2 and 5 mo postpartum and were not associated substantially with milk volume (except for β-carotene, α-carotene, and β-cryptoxanthin). At 5 mo postpartum, associations between maternal micronutrient status and corresponding milk concentrations reported as mean percentage difference in human milk concentration for each unit higher maternal biomarker were significant for hemoglobin (1.9%), iron biomarkers (ranging from 0.4 to 7%), RBP (35%), selenium (70%), and vitamin B-12 (0.1%), yet for maternal intakes only a positive association with β-carotene existed.ConclusionsMost milk micronutrient concentrations declined during lactation, independent of changes in human milk production, and few were associated with maternal micronutrient intakes. The significant associations between maternal biomarkers and milk micronutrient concentrations at 5 mo warrant further study to investigate whether the declines in milk micronutrients are linked to shifts in maternal status.

Prevalence of inadequate intake of vitamins and minerals in the Mexican population correcting by nutrient retention factors, Ensanut 2016.

To estimate the usual intake and the prevalence of inadequacy of selected nutrients in the Mexican population and the potential effect that the nutrient retention factors (NRF) could have on these estimates. Likewise, document the methodology used in the analysis of the 24 hours of the mid-way National Health and Nutrition Survey 2016 (Ensanut MC 2016). Dietary information from the Ensanut MC 2016 was analyzed with and without the use of NRFs. Results. Most nutrients evaluated showed a relevant inadequacy prevalence above 10% in all age groups. Likewise, we documented that, when NRFs were not applied, estimated intakes and prevalence were significantly under-estimated in a range of 2% to 55.5%. We documented the relevance of the application of NRFs for adequate estimation of the prevalence of inadequate intake of selected nutrients in population studies.

Micronutrient intake and prevalence of micronutrient inadequacy among women (15-49 y) and children (6-59 mo) in South Kivu and Kongo Central, Democratic Republic of the Congo (DRC).

Iron biofortified beans and carotenoid enriched cassava are proposed as a solution to combat iron and vitamin A deficiencies, respectively, in the Democratic Republic of Congo (DRC). To inform the need for biofortified foods, we conducted a survey in 2014 in two provinces of the DRC, South Kivu and Kongo Central. Unexpectedly, women of reproductive age (WRA; 15-49 y) and their children (6-59 m) had a low prevalence of biochemical iron and vitamin A deficiency, based on ferritin and retinol binding protein, respectively. To better understand the lack of biochemical deficiency of these nutrients, we examined the prevalence of inadequate intake for these and other select nutrients. Dietary intake was assessed using 24-hour recalls among 744 mother-child dyads. Repeat recalls on a non-consecutive day were conducted with a subsample of the study population to account for intra-individual variation and estimate usual intake. In WRA, the prevalence of inadequate iron intakes were 33% and 29% in South Kivu and Kongo Central, respecitvely. The prevalence of inadequate vitamin A intakes among WRA was low in South Kivu (18%) and negligible in Kongo Central (1%). Iron inadequacy was highest in infants (6-11 m) at 82% and 64% in South Kivu and Kongo Central, respectively. Among older children (12-59 m) in both provinces, the prevalence of iron inadequacy was similar at ~20%. There was a high prevalence of inadequate zinc intake in women and children (i.e. 79-86% among WRA and 56-91% among children 6-59 m) consistent with our findings of a high prevalence of low serum zinc in the same sample. Dietary data here corroborate the low prevalence of biochemical vitamin A deficiency but not iron. However, any change to the supply of red palm oil (primary source of vitamin A) would dramatically reduce population vitamin A intakes, thus a carotenoid enriched cassava program may be beneficial as a safety net measure. Crops biofortified with zinc also appear warranted. We caution that our findings cannot be extrapolated to the entire Congo where diverse agro-ecological landscape exist or when political and environmental shocks occur which challenge food production.

Dietary Intakes, Patterns, and Determinants of Children Under 5 Years from Marginalized Communities in Odisha: A Cross-sectional Study

Pre-school age (3–5 years) children are vulnerable to malnutrition due to poor dietary intake, dietary habits, and socio-economic conditions. Children from marginalized families are more vulnerable than non-marginalized families due to limited access to health- and nutrition-related services, besides other socio-economic factors. This study was done to assess the dietary intakes, patterns, and determinants of pre-school age (3–5 years) children from marginalized populations in two districts of Odisha. We used three different questionnaires, namely general demographic information, single 24-h recall dietary survey, and food frequency questionnaire, to collect data. Dietary patterns were obtained using principal component analysis, and the recommended dietary allowance (RDA) method was applied to estimate the prevalence of inadequate intake. A general linear model of regression was used to investigate the relationship of dietary patterns scores with independent variables. A total of 86 boys (57.3%) and 64 girls (42.7%) were recruited for the study. The majority (more than two-third) of the children had <70% of RDA of iron, vitamin C, and zinc. The three dietary components that best described the dietary patterns among children in the study were vegetarian, non-vegetarian, and mixed patterns. They explained 54.9% of the variability. The ‘vegetarian’ dietary pattern was inversely associated with children whose mothers were illiterate (p = 0.005), who lived in families having per capita family monthly income less than INR 786 (10.3 US$) (p = 0.007), and who were first born (p = 0.04). The dietary patterns may help interventionists in designing programs aimed at preventing malnutrition and chronic diseases among children in marginalized communities.

Food Sources and Nutrient Intakes of Filipino Working Adults.

Nutrition is an integral part of economic development, since it influences workers’ health and productivity. This study evaluated the usual nutrient intakes and food sources of working adults. We conducted a cross-sectional survey that involved 1264 selected working adults aged 19 to 59 years old from randomly selected job sectors. Quantitative dietary data was collected by a 2-day, non-consecutive 24 h recall, while a dietary diversity questionnaire was used to assess the types and frequency of foods consumed. Physical activity was measured using the World Health Organization global physical assessment questionnaire. The prevalence of inadequate intakes, defined as the percentage of adults with intakes less than the estimated average requirements (EAR) or acceptable macronutrient distribution ranges (AMDR) were estimated using the PC—Software for Intake Distribution Estimation (PC-SIDE) program. The mean daily energy intake of working adults was 1768 kcal/day or 74% of the Estimated Energy Requirements (EER) for this age group. The percentage contribution to the total energy of fats (58%) and proteins (34%) were excessively high. Consumption of fruits and vegetables was only 30% and 40% of the recommended nutrient intake, respectively. Salt intake was 52% above the adequate intake. Nutrient inadequacy was high in almost all nutrients, including iron (99%), folate (97.9%), riboflavin (95.8%), calcium (94.7%), vitamin C (87.3%), and thiamin (76.6%). The top five food sources of energy included rice (35.6%), pork (15.1%), fats and oils (4.7%), chicken (4.4%), and bread (3.8%). Energy and nutrient intakes of working adults is extremely sub-optimal due to the consumption of few nutrient-dense foods. This may pose a triple burden of malnutrition if left unsolved.

Pregnant Women in Four Low-Middle Income Countries Have a High Prevalence of Inadequate Dietary Intakes That Are Improved by Dietary Diversity.

Background: Up-to-date dietary data are required to understand the diverse nutritional challenges of pregnant women living in low-middle income countries (LMIC). To that end, dietary data were collected from 1st trimester pregnant women in rural areas of Guatemala, India, Pakistan, and Democratic Republic of the Congo (DRC) participating in a maternal lipid-based nutrient supplement (LNS) Randomized Controlled Trial to examine dietary diversity (DD), usual group energy and nutrient intakes, and prevalence of inadequate dietary intakes. Methods: Two 24-h dietary recalls were conducted in ~240 pregnant women/site (total n = 966) prior to 12-week gestation. Adequate DD was assessed, i.e., ≥5 major food groups consumed within the past 24 h. Median, Q1, Q3 intakes (without LNS) of energy, macronutrients, 12 micronutrients, and phytate were examined. The “at risk” prevalence of inadequate intakes were based on international guidelines for pregnant women. Results: Dietary patterns varied widely among sites, with adequate DD reported: 20% (Pakistan), 25% (DRC), 50% (Guatemala), and 70% (India). Significantly higher intakes of most key nutrients were observed in participants with adequate DD. More than 80% of women in all sites had inadequate intakes of folate, vitamin B12, and choline, and >80% of women in India and DRC also had inadequate intakes of calcium, thiamine, riboflavin, and vitamin B6. Conclusions: Our data highlight the likely need for micronutrient supplementation in pregnancy, specifically multi-micronutrient interventions, and support the value of increasing DD as part of sustainable long-term nutrition programs for women of reproductive age in these poor rural settings in LMIC.

Using Household Surveys and Other Secondary Data to Assess the Need for and Impacts of Micronutrient Interventions (FS01-03-19)

ObjectivesGiven the scarcity of nationally-representative dietary intake data in most low- and middle-income countries, our objective was to compare estimates of micronutrient (MN) intake and predicted MN intervention effectiveness generated using household consumption and expenditure surveys (HCES) and other secondary data vs individual-level 24-hr dietary recalls (24HR), focusing on vitamin A (VA) in children and iron in women of reproductive age (WRA). MethodsWe calculated “apparent” food consumption using HCES data from Cameroon and applied the adult male equivalent method to estimate individual-level food intake. For children, intake was matched with food composition data to calculate VA intake, inadequate intake, and, combined with Demographic and Health Survey (DHS) data, effective coverage (shift from inadequate to adequate intake) of VA interventions. For WRA, we combined DHS data with HCES estimates of fortifiable food intake to predict cases of iron deficiency anemia averted. Results were compared to those generated by modeling data from a national 24HR survey. ResultsMean apparent VA intake among children 6–59 mo from HCES data was similar to 24HR estimates for non-breastfed children (206 vs 215 μg RAE/d) and followed the same sub-national pattern (highest in the South macro-region, followed by the cities, and lowest in the North). Prevalence of inadequate intake was also similar (64% vs 59% nationally). Both data sources predicted effective coverage was highest for VA supplements, micronutrient powders, and oil fortification (Fig. 1).Preventive iron supplements to WRA was predicted to avert a relatively high proportion of anemia based on both the 24HR (24–62% of cases of anemia averted in the cities, 15–26% in the North, and 12–57% in the South) and secondary data (28–60%, 17–37%, and 27–56%). Iron-fortified wheat flour (60 ppm) and bouillon cubes (600 ppm) were predicted to avert few cases of anemia among WRA (<7% and <3%, respectively) in all macro regions. ConclusionsWhere dietary intake data are unavailable, secondary data may be useful for identifying effective MN interventions. Challenges include uncertainty about intrahousehold food distribution, MN intake from breastmilk, and combining multiple secondary data sources. Funding SourcesThis study is based on research funded by a grant to UC Davis from the Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs▪

Adult’s Dietary Intakes of Selected Vitamins & Minerals Essential for Energy Metabolism and Cognition: A Comparison Across Countries & Genders (FS10-04-19)

ObjectivesVitamins and minerals dietary intake recommendations rely on their role on energy-yielding metabolism, cognitive functions and fatigue relief. However, even in adult populations, reliable information on the actual dietary intake is not easily available. In this study, possible gaps between recommendation and actual intake of these micronutrients were assessed in adult European (Spain &Turkey), American (USA, Brazil & Mexico) and Asian (Vietnam) populations. It aimed to provide an overview of the risk of inadequate intake and to identify potential variations across geographic regions and genders. MethodsIn each country, information was retrieved from representative nation-wide dietary survey, government reports and Medline scientific publications. Prevalence of inadequate intake was classified as the proportion of the population group with an intake below the estimated average requirement (EAR) as follows: <15%: low risk (green); 15 to 40%: possible risk (yellow); 41 to 75%: real risk (orange); >75%: high risk (red). ResultsThe risk of inadequate intake of micronutrients known for their role on physical and mental performance varied across nutrients, genders and countries (Table 1). Some common features were identified across the six countries such as a higher risk of deficiency in women compared to men and in developing vs developed countries. Certain specific risks were identified namely a high risk of inadequate folate intake in Spain, a wide geographical risk of inadequate vitamin C intake even where fruits should be easily available, and a general risk for most micronutrients in Turkey. ConclusionsInadequate dietary intakes are far from being uncommon in most countries in the selected micronutrients that are key for the energy metabolism, cognitive functions and fatigue relief. Therefore, diets and nutritional education need constant improvement worldwide, and dietary supplements could be helpful by closing the gaps between the recommended and the actual intakes. Funding SourcesThis study has been sponsored by Sanofi. Supporting Tables, Images and/or Graphs▪

Using Household Surveys and Other Secondary Data to Assess the Need for and Impacts of Micronutrient Interventions (FS01-03-19)

ObjectivesGiven the scarcity of nationally-representative dietary intake data in most low- and middle-income countries, our objective was to compare estimates of micronutrient (MN) intake and predicted MN intervention effectiveness generated using household consumption and expenditure surveys (HCES) and other secondary data vs individual-level 24-hr dietary recalls (24HR), focusing on vitamin A (VA) in children and iron in women of reproductive age (WRA). MethodsWe calculated “apparent” food consumption using HCES data from Cameroon and applied the adult male equivalent method to estimate individual-level food intake. For children, intake was matched with food composition data to calculate VA intake, inadequate intake, and, combined with Demographic and Health Survey (DHS) data, effective coverage (shift from inadequate to adequate intake) of VA interventions. For WRA, we combined DHS data with HCES estimates of fortifiable food intake to predict cases of iron deficiency anemia averted. Results were compared to those generated by modeling data from a national 24HR survey. ResultsMean apparent VA intake among children 6–59 mo from HCES data was similar to 24HR estimates for non-breastfed children (206 vs 215 μg RAE/d) and followed the same sub-national pattern (highest in the South macro-region, followed by the cities, and lowest in the North). Prevalence of inadequate intake was also similar (64% vs 59% nationally). Both data sources predicted effective coverage was highest for VA supplements, micronutrient powders, and oil fortification (Fig. 1).Preventive iron supplements to WRA was predicted to avert a relatively high proportion of anemia based on both the 24HR (24–62% of cases of anemia averted in the cities, 15–26% in the North, and 12–57% in the South) and secondary data (28–60%, 17–37%, and 27–56%). Iron-fortified wheat flour (60 ppm) and bouillon cubes (600 ppm) were predicted to avert few cases of anemia among WRA (< 7% and < 3%, respectively) in all macro regions. ConclusionsWhere dietary intake data are unavailable, secondary data may be useful for identifying effective MN interventions. Challenges include uncertainty about intrahousehold food distribution, MN intake from breastmilk, and combining multiple secondary data sources. Funding SourcesThis study is based on research funded by a grant to UC Davis from the Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs▪

Diet quality and nutrient density in subjects with metabolic syndrome: Influence of socioeconomic status and lifestyle factors. A cross-sectional assessment in the PREDIMED-Plus study

Socioeconomic disparities and lifestyle factors are likely to determine the overall quality of the diet. In addition, overeating is compatible with inadequate micronutrient intake and it can lead to adverse health outcomes. To assess adequacy of dietary nutrient intake and to investigate the influence of socioeconomic and lifestyle factors on nutrient density in a large primary cardiovascular prevention trial conducted in healthy participants with metabolic syndrome (MetS) to assess the cardiovascular effects of an energy-restricted Mediterranean diet (PREDIMED-Plus). Baseline cross-sectional analysis of the PREDIMED-Plus trial with 6646 Spanish participants (aged 55-75 years in men and 60-75 years in women) with overweight/obesity and MetS. Energy and nutrient intake (for 10 nutrients) were calculated using a validated 143-item Food Frequency Questionnaire (FFQ) and nutrient density was estimated dividing the absolute nutrient intake by total energy intake. The prevalence of inadequate intake was estimated according to dietary reference intakes. Multivariable linear regression models were fitted to examine associations between socioeconomic status or lifestyle factors and nutrient density. A considerable proportion of the screened participants showed a deficient intake of vitamins A, D, E, B9, calcium, magnesium and dietary fibre. Inadequate intake of four or more of the ten nutrients considered was present in 17% of participants. A higher nutrient density was directly and significantly associated with female sex, higher educational level and a better adherence to the Mediterranean diet. Lifestyle factors such as non-smoking and avoidance of sedentary lifestyles were also independently associated with better nutrient density. Patients with MetS, despite being overweight, exhibited suboptimal nutrient intake, especially among men. Low nutrient density diet can be largely explained by differences in socioeconomic and lifestyle factors. These results highlight the importance of focussing on nutritional education in vulnerable populations, taking into account nutrient requirements.

Excess nutritional risk in infants and toddlers in a Spanish city.

Adequate dietary intake is vital for infants' growth and development. The aim was to analyse food consumption and energy and nutrient intakes in a group of healthy Spanish infants and toddlers. Cross-sectional study. 154 infants were assessed at 6 months, and followed at 12 and 30 months. Clinical history, anthropometry, type of feeding, food consumption and energy and nutrient intakes (24-hours recall) were estimated. Advice about food consumed, estimated average requirements, the prevalence of inadequate intakes and percentage of adequacy of the recommended dietary allowance were applied. Toddlers had an excessive daily consumption of meat (>51.3g/day), milk (>545g/day), fish (>20.8g/day) and free-sugar foods (>30.5g/day). This consumption was related to a very high intake of proteins (>18%) and free sugars (>10%), at 12 and 30 months, as a percentage of daily energy intake. The mean prevalence of inadequacy intakes was above 48% for iron at 6 months, and 68% and 87% for vitamin D at 12 and 30 months, respectively. At 6 months, infants who were breastfed had greater adequacy in energy and nutrients to recommended dietary, while infants fed infant formula had a higher intake (>120% compared with RDA) in vitamins E, C, B1, B2, pantothenic acid, B6, B12 and folic acid. The contribution of micronutrients in infant formula should be reviewed, appropriate protein and free sugars should be provided during complementary feeding, as well as strategies to avoid vitamin D deficiency since childhood; and continue with the promotion of breastfeeding.