Prevalence Of Inadequate Micronutrient Intake Research Articles

P18-029-23 Prevalence of Inadequate Micronutrient Intake Among Non-Pregnant Non-Lactating Women of Reproductive Age in Mbeya Region, Tanzania

P18-029-23 Prevalence of Inadequate Micronutrient Intake Among Non-Pregnant Non-Lactating Women of Reproductive Age in Mbeya Region, Tanzania

Micronutrient intake inadequacies in different types of milk consumers in Indonesian children 1-5 years: dietary modeling with young child milk improved nutrient intakes.

Indonesian children under-five have a high prevalence of micronutrient deficiencies. Improving young child feeding practices may be the solution. Increasing the consumption of appropriate milk products could help to reduce nutrient inadequacy. The objective of this study was to assess nutrient inadequacy in Indonesian children to evaluate the potential improvement using dietary modeling analysis. Data from children aged 1-5 years from the Indonesian Individual Dietary Consumption Survey in 2014 were used in this analysis (n = 11,020). Diet modeling was conducted in two scenarios, substitution volume to volume and calories to calories. The proportion of children consuming young child milk (YCM) was the highest compared to other milk types across all age groups, followed by condensed milk and cow's milk. YCM, also called "Growing-Up Milk" (GUM), are marketed as a product specifically formulated for the nutritional needs of young children. YCM consumers had lower prevalence of inadequate intakes in iron, zinc, vitamins A, C and D across age groups when compared to condensed milk consumers. The prevalence of inadequate intakes of nutrients in condensed milk consumers was Vitamin A (67, 64%), folate (92, 91%), Vitamin D (87, 84%), iron (84, 76%), and zinc (76, 76%) in 1-2y and 3-4y, respectively. The substitution of condensed milk with a YCM reduced the prevalence of inadequate intakes of micronutrients, such as Vitamin A, vitamin D, folate, iron and zinc, which are important for immune function. YCM reduced the prevalence of inadequate intakes of micronutrients by 20-40% (Vit A and folate) and 40-50% (Vit D and zinc). The reduction of prevalence of inadequate iron intake was 31% in 1-2y and 63% in 3-4y. The prevalence of inadequate micronutrient intakes was high among children aged 1-5 years old in Indonesia. YCM consumers had better nutrient intake. The substitution of condensed milk with a YCM reduced the prevalence of inadequate of micronutrient intake. Thus, nutrient intakes could be improved by YCM consumption in 1-5 years old children in Indonesia, along with nutrition education on feeding practices.

Dietary Intake of Micronutrients and Disease Severity in Patients with Amyotrophic Lateral Sclerosis.

Vitamins and essential metals have been studied as potential risk and prognostic factors in amyotrophic lateral sclerosis (ALS). This study aimed to evaluate the prevalence of inadequate micronutrient intake in ALS patients, comparing subgroups according to the disease severity. Data were obtained from the medical records of 69 individuals. Assessment of disease severity was determined by the revised ALS Functional Scale (ALSFRS-R), using the median as the cutoff. The prevalence of inadequate micronutrient intake was estimated using the Estimated Average Requirements (EAR) cut-point method. The prevalence of inadequate vitamin D, E, riboflavin, pyridoxine, folate, cobalamin, calcium, zinc, and magnesium intake was considered severe. Patients with lower ALSFRS-R scores had lower intakes of vitamin E (p < 0.001), niacin (p = 0.033), pantothenic acid (p = 0.037), pyridoxin (p = 0.008), folate (p = 0.009) and selenium (p = 0.001). Therefore, ALS patients should be monitored regarding dietary intake of micronutrients essential in neurological processes.

Prevalence and Risk Factors of Inadequate Micronutrient Intake among Children Aged 6-23 Months in Indonesia

Background: Poor quality and quantity are the main factors that contribute to the increasing inadequacy of micronutrients intake such as Iron, Calcium, Zinc, Vitamins A, and C since the complementary food was introduced at 6 months of infant’s age. Objectives: To analyze the prevalence and risk factors of inadequate micronutrients intake among children aged 6-23 months in Indonesia. Methods: A cross-sectional study used Individual Food Consumption Survey 2014 data from Indonesian Health Study and Development Agency involving 1575 children aged 6-23 months as the total subjects. Minimum Dietary Diversity (MDD) was measured by eight food groups for children under two years old. The prevalence of inadequate micronutrients intake used the probability approach. Binary logistic regression was used as a multivariate test to determine the risk factors of inadequate micronutrients intake. Results: The highest prevalence of inadequate micronutrients intake was vitamin C, while the lowest was zinc, with overall inadequate multiple micronutrients intake being 61.9%. About 57.7% and 15.9% of subjects were low in energy intake and achieved the MDD, respectively. Lived in rural area [OR=1.37(95%CI:1.06-1.77)], low education mother [OR=1.71(95%CI:1.32-2.22)], low energy intake [OR=6.22(95%CI:4.84-7.99)] and not achieved MDD [OR=4.84(95%CI:3.47-6.75)] were more likely to have inadequate micronutrients intake, while not consuming breast milk were less likely to have inadequate micronutrients intake in children [OR=0.55(95%CI:0.43-0.71)]. Conclusions: Almost two-thirds of subjects were inadequate in overall multiple micronutrients. Low energy intake and not achieved MDD were the highest risk of inadequate micronutrients intake of subjects, instead of low mother education and living in rural areas.

Lack of Association between Inadequate Micronutrient Intake and Prognosis in Outpatients with Heart Failure.

Inadequate nutrient intake can lead to worse outcomes in patients with heart failure (HF). This prospective cohort study aimed to assess the prevalence of inadequate micronutrient intake and their association with prognosis in 121 adult and elderly outpatients with HF. Habitual micronutrient intake was evaluated using 24-h dietary recalls (minimum 2 and maximum 6). Participants were grouped into moderate (n = 67) and high (n = 54) micronutrient deficiency groups, according to the individual assessment of each micronutrient intake. Patients’ sociodemographic, clinical, and anthropometric data and clinical outcomes (hospitalization and mortality) within 24 months were collected. Overall and event-free survival rates were calculated using Kaplan–Meier estimates, and curves were compared using the log-rank test. The death risk rate (hazard ratio (HR)) was calculated using Cox’s univariate model. The rate of inadequate intake was 100% for vitamins B1 and D and above 80% for vitamins B2, B9, and E, calcium, magnesium, and copper. No differences in overall survival and event-free survival were observed between groups of HF outpatients with moderate and high micronutrient deficiencies (HR = 0.94 (CI = 0.36–2.48), p = 0.91, and HR = 1.63 (CI = 0.68–3.92), p = 0.26, respectively), as well as when the inadequacy of each micronutrient intake was evaluated alone (all p > 0.05). In conclusion, a high prevalence of inadequate micronutrient intake was observed in outpatients with HF. Inadequate micronutrient intake was not associated with hospitalization and mortality in this group of patients.

Micronutrient supply from global marine fisheries under climate change and overfishing

Fish are rich in bioavailable micronutrients, such as zinc and iron, deficiencies of which are a global food security concern.1,2 Global marine fisheries yields are threatened by climate change and overfishing,3,4 yet understanding of how these stressors affect the nutrients available from fisheries is lacking.5,6 Here, using global assessments of micronutrient content2 and fisheries catch data,7 we investigate how the vulnerability status of marine fish species8,9 may translate into vulnerability of micronutrient availability at scales of both individual species and entire fishery assemblages for 157 countries. We further quantify the micronutrient evenness of catches to identify countries where interventions can optimize micronutrient supply. Our global analysis, including >800 marine fish species, reveals that, at a species level, micronutrient availability and vulnerability to both climate change and overfishing varies greatly, with tropical species displaying a positive co-tolerance, indicating greater persistence to both stressors at a community level.10 Global fisheries catches had relatively low nutritional vulnerability to fishing. Catches with higher species richness tend to be nutrient dense and evenly distributed but are more vulnerable to climate change, with 40% of countries displaying high vulnerability. Countries with high prevalence of inadequate micronutrient intake tend to have the most nutrient-dense catches, but these same fisheries are highly vulnerable to climate change, with relatively lower capacity to adapt.11 Our analysis highlights the need to consolidate fisheries, climate, and food policies to secure the sustainable contribution of fish-derived micronutrients to food and nutrition security.

Diet and supplement assessment in a Brazilian urban population.

ABSTRACTOBJECTIVE:To assess total usual nutrient intakes from foods and dietary supplements by age, sex, physical activity, and nutritional status, and to compare usual nutrient intakes to the Dietary Reference Intakes among non-users and users of dietary supplements in an urban population.METHODS:Cross-sectional population-based survey with 506 adults conducted in the city of Brasília, Brazil, using 24h food recalls. The 24-HR was collected on two nonconsecutive days, for which individuals reported all food, supplements, and beverages consumed in the previous 24 hours. The estimates of mean and the distribution percentiles were adjusted to reflect usual nutrient intake using the Iowa State University method. The prevalence of inadequate micronutrient intake was estimated according to sex using the Estimated Average Requirement (EAR), and values above the Tolerable Upper Intake Level (UL) were also considered. Also, a comparison was made of the total mean usual intake between supplement users and non-users according to BMI and physical activity.RESULTS:The total mean usual dietary intake was significantly higher among users than non-users of dietary supplements (p ≤ 0.02). Dietary supplement use increased intakes of nutrients and decreased prevalence of inadequacy according to sex, with only small (typically < 13%) increases in the population exceeding the Tolerable Upper Intake Level. There was a significant interaction between physical activity and BMI categories with supplement use.CONCLUSIONS:The population that consumes food supplements comprises individuals with more advanced age, female, normal BMI, and physically active. Our findings show that the use of supplements appears beneficial to attain nutrient adequacy. Careful monitoring of intake from food and supplements is recommended, and the statistical methods must be powerful enough to achieve relevant information.

Micronutrient Fortification of Commercially Available Biscuits Is Predicted to Have Minimal Impact on Prevalence of Inadequate Micronutrient Intakes: Modeling of National Dietary Data From Cameroon.

ABSTRACTBackgroundVoluntarily fortified snack products are increasingly available but are not necessarily formulated to meet known dietary nutrient gaps, so potential impacts on population micronutrient intake adequacy are uncertain.ObjectivesWe modeled the impacts of hypothetical micronutrient-fortified biscuits on inadequate micronutrient intake in children and women of reproductive age (WRA) in Cameroon.MethodsIn a nationally representative survey stratified by macro-region (North, South, and Yaoundé/Douala), 24-h dietary recall data were collected from 883 children aged 12–59 mo and from 912 WRA. We estimated usual nutrient intake by the National Cancer Institute method for vitamin A, folate, vitamin B-12, zinc, and iron. We simulated the impact of biscuit fortification on prevalence of micronutrient intake below the estimated average requirement, given observed biscuit consumption, in the presence and absence of large-scale food fortification (LSFF) programs.ResultsBiscuit consumption in the prior 24-h by children and WRA, respectively, ranged from 4.5% and 1.5% in the South, to 20.7% and 5.9% in Yaoundé/Douala. In the absence of LSFF programs, biscuits fortified with retinol (600 μg/100 g), folic acid (300 μg/100 g), and zinc (8 mg/100 g) were predicted to reduce the prevalence of inadequacy among children by 10.3 ± 4.4, 13.2 ± 4.2, and 12.0 ± 6.1 percentage points, respectively, in Yaoundé/Douala. However, when existing vitamin A–fortified oil, and folic acid–fortified and zinc-fortified wheat flour programs were considered, the additional impacts of fortified biscuits were reduced substantially. Micronutrient-fortified biscuits were predicted to have minimal impact on dietary inadequacy in WRA, with or without LSFF programs.ConclusionsGiven observed patterns of biscuit consumption in Cameroon, biscuit fortification is unlikely to reduce dietary inadequacy of studied micronutrients, except possibly for selected nutrients in children in urban areas in the absence of LSFF programs. As voluntary fortification becomes increasingly common, modeling studies could help guide efforts to ensure that fortified products align with public health goals.

Maternal dietary diversity during pregnancy and congenital heart defects: a case-control study.

Maternal diet is critical to fetal development. This study aimed to explore the association between maternal dietary diversity during pregnancy and congenital heart defects (CHD) in Chinese population. A hospital-based case-control study was conducted including 474 cases and 948 controls in Northwest China. We recruited eligible women waiting for delivery in the hospital and gathered their diets during the whole pregnancy by a validated food frequency questionnaire. According to the FAO Minimum Dietary Diversity for Women (MDD-W) guideline, the participants were categorized into "inadequate dietary diversity score (DDS)" (DDS < 5) and "adequate DDS" (DDS ≥ 5) groups. The association between dietary diversity and CHD was estimated using the mixed logistic regression models. Case mothers had a lower DDS during pregnancy than the controls (P < 0.001). The proportions of women consuming all the ten defined food groups were lower in the inadequate DDS group than in the adequate DDS group among both cases and controls (all P < 0.001). The prevalence of inadequate micronutrient intake was higher in the inadequate DDS group than in the adequate DDS group among both cases and controls (all P < 0.05). Women in the adequate DDS group had reduced risks of having fetuses with total CHD (OR = 0.62, 95% CI = 0.45-0.84) and ventricular septal defects (OR = 0.58, 95% CI = 0.38-0.88). Adequate DDS during pregnancy might be associated with a lower risk of CHD in offspring. Efforts to promote dietary diversity during pregnancy need to be strengthened to reduce the prevalence of CHD in Chinese population.

Intakes of energy, macronutrients and micronutrients of a population in severe food insecurity risk in Brazil - ERRATUM.

Objective To analyse usual intakes of energy, macronutrients and micronutrients, and their percentage of inadequacy, in a Brazilian population at severe food insecurity (SFI) risk, determined from a predictive model using two national databases. Design Cross-sectional study. Our study used a statistical model to predict SFI using the 2009 National Sample Household Survey, where the Brazilian Food Insecurity Scale measured SFI. Setting Brazil. Participants The model was applied in a probabilistic sample of 34 003 Brazilians aged 10 years or older that participated in a national dietary survey during 2008-2009. The application of the model generated the probability of each individual being in SFI. The probability of SFI was grouped into quartiles (first quartile with the lowest SFI risk, fourth quartile with highest probability of SFI risk). Results The intakes of macro- and micronutrients were associated with SFI. The amount of energy and nutrients in the diet tended to be lower among individuals in the fourth quartile, with highest probability of SFI. The average intake of all studied minerals (Ca, Fe, Na, Mg) was less in individuals in the fourth quartile. Only Na presented a higher percentage of inadequacy in the first quartile, the one with a lower chance of SFI. Conclusions The food intake of the Brazilian population at higher SFI risk is characterized by energy reduction, reduced consumption of macronutrients and high prevalence of inadequate micronutrient intakes, as well as a lower mean intakes, when compared with the first quartile with the lowest SFI risk.

Processed and ultra-processed foods are associated with high prevalence of inadequate selenium intake and low prevalence of vitamin B1 and zinc inadequacy in adolescents from public schools in an urban area of northeastern Brazil.

Changes in eating behavior of adolescents are associated with high consumption of processed and ultra-processed foods. This study evaluated the association between these foods and the prevalence of inadequate micronutrient intake in adolescents. A cross-sectional study was conducted with 444 adolescents from public schools in the city of Natal, northeastern Brazil. The adolescents' habitual food consumption was evaluated using two 24-hour dietary recalls. Foods were categorized according to the degree of processing (processed and ultra-processed) and distributed into energy quartiles, using the NOVA classification system. Inadequacies in micronutrient intake were assessed using the estimated average requirement (EAR) as the cutoff point. Multivariate logistic regression models were used to estimate the relationship between energy percentage from processed and ultra-processed foods and prevalence of inadequate micronutrient intake. The mean (Standard Deviation (SD)) consumption of total energy from processed foods ranged from 5.8% (1.7%) in Q1 to 20.6% (2.9%) in Q4, while the mean consumption of total energy from ultra-processed foods ranged from 21.4% (4.9%) in Q1 to 61.5% (11.7%) in Q4. The rates of inadequate intake of vitamin D, vitamin E, folate, calcium, and selenium were above 80% for both sexes across all age groups. Energy consumption from processed foods was associated with higher prevalence of inadequate selenium intake (p < 0.01) and lower prevalence of inadequate vitamin B1 intake (p = 0.04). Energy consumption from ultra-processed foods was associated with lower prevalence of inadequate zinc and vitamin B1 intake (p < 0.01 and p = 0.03, respectively). An increase in the proportion of energy obtained from processed and ultra-processed foods may reflect higher prevalence of inadequate selenium intake and lower prevalence of vitamin B1 and zinc inadequacy.

Intakes of energy, macronutrients and micronutrients of a population in severe food insecurity risk in Brazil.

To analyse usual intakes of energy, macronutrients and micronutrients, and their percentage of inadequacy, in a Brazilian population at severe food insecurity (SFI) risk, determined from a predictive model using two national databases. Cross-sectional study. Our study used a statistical model to predict SFI using the 2009 National Sample Household Survey, where the Brazilian Food Insecurity Scale measured SFI. Brazil. The model was applied in a probabilistic sample of 34 003 Brazilians aged 10 years or older that participated in a national dietary survey during 2008-2009. The application of the model generated the probability of each individual being in SFI. The probability of SFI was grouped into quartiles (first quartile with the lowest SFI risk, fourth quartile with highest probability of SFI risk). The intakes of macro- and micronutrients were associated with SFI. The amount of energy and nutrients in the diet tended to be lower among individuals in the fourth quartile, with highest probability of SFI. The average intake of all studied minerals (Ca, Fe, Na, Mg) was less in individuals in the fourth quartile. Only Na presented a higher percentage of inadequacy in the first quartile, the one with a lower chance of SFI. The food intake of the Brazilian population at higher SFI risk is characterized by energy reduction, reduced consumption of macronutrients and high prevalence of inadequate micronutrient intakes, as well as a lower mean intakes, when compared with the first quartile with the lowest SFI risk.

Review of the evidence regarding the use of antenatal multiple micronutrient supplementation in low- and middle-income countries.

Inadequate micronutrient intakes are relatively common in low‐ and middle‐income countries (LMICs), especially among pregnant women, who have increased micronutrient requirements. This can lead to an increase in adverse pregnancy and birth outcomes. This review presents the conclusions of a task force that set out to assess the prevalence of inadequate micronutrient intakes and adverse birth outcomes in LMICs; the data from trials comparing multiple micronutrient supplements (MMS) that contain iron and folic acid (IFA) with IFA supplements alone; the risks of reaching the upper intake levels with MMS; and the cost‐effectiveness of MMS compared with IFA. Recent meta‐analyses demonstrate that MMS can reduce the risks of preterm birth, low birth weight, and small for gestational age in comparison with IFA alone. An individual‐participant data meta‐analysis also revealed even greater benefits for anemic and underweight women and female infants. Importantly, there was no increased risk of harm for the pregnant women or their infants with MMS. These data suggest that countries with inadequate micronutrient intakes should consider supplementing pregnant women with MMS as a cost‐effective method to reduce the risk of adverse birth outcomes.

Brazilian preschool children attending day care centers show an inadequate micronutrient intake through 24-h duplicate diet

Inadequate micronutrient intake in childhood harms growth and development, and it is related to increased rates of morbidity and mortality. The aim of this study is to evaluate the dietary intake and prevalence of inadequate micronutrient intake in preschool children (1–4 years old) attending two-day care centers. To assess children’s dietary micronutrient intake, 24-h duplicate diets (n = 64) were collected for one week-day, including everything the children ate and drank both at home and in kindergarten. Anthropometric measurements were carried out to evaluate the children’s nutritional status. The micronutrients copper, iron, calcium, magnesium, selenium, zinc, potassium, sodium, and manganese were determined by inductively coupled plasma mass spectrometry or graphite furnace atomic absorption spectrometry. Calcium and selenium were found with high inadequate intake rates: 50% and 42%, respectively, for children aged 1–3 years old, and 93% and 90% for children aged 4 years. Potassium was consumed in very low amounts, 13% and 5% of children aged 1–3 and 4 years old, respectively, achieved the adequate intake for the nutrient. Sodium intakes were excessive: 23% of the 1–3-year old and 42% of the 4-year-old children, respectively, had an intake higher than the tolerable upper levels. Regarding the nutritional status, overweight and obesity prevalence was 17%. Therefore, considering the damaging health effects for children of micronutrient deficiency and overweight and obesity status, it is necessary that government authorities be aware and update public policies and educational programs in order to promote healthy eating habits in early childhood.

Nut Consumptions as a Marker of Higher Diet Quality in a Mediterranean Population at High Cardiovascular Risk.

Background: Nut consumption has been associated with improved nutrient adequacy and diet quality in healthy adult populations but this association has never been explored in individuals at high cardiovascular risk. Objective: to assess the associations between consumption of nuts and nutrient adequacy and diet quality in a Mediterranean population at high cardiovascular risk. Design: baseline assessment of nutritional adequacy in participants (n = 6060, men and women, with ages 55–75 years old, with overweight/obesity and metabolic syndrome) in the PREDIMED-PLUS primary cardiovascular prevention randomized trial. Methods: nut intake was assessed using a validated food frequency questionnaire. Participants who reported consuming zero quantity of nuts were classified as ‘non-nut consumers’. ‘Nut consumers’ were participants who reported consuming any quantity of nuts. Nineteen micronutrients were examined (vitamins B1, B2, B3, B6, B12, A, C, D, E and folic acid; Ca, K, P, Mg, Fe, Se, Cr, Zn, and iodine). The proportion of micronutrient inadequacy was estimated using the estimated average requirements (EAR) or adequate intake (AI) cut-points. Diet quality was also assessed using a 17-item Mediterranean dietary questionnaire (Mediterranean diet score, MDS), a carbohydrate quality index (CQI) and a fat quality index (FQI). Results: eighty-two percent of participants were nut consumers (median of nut consumption 12.6 g/day; interquartile range: 6.0–25.2). Nut consumers were less likely to be below the EAR for vitamins A, B1, B2, B6, C, D, E, folic acid, and Ca, Mg, Se and Zn than non-nut consumers. Nut consumers were also more likely to be above the AI for K and Cr than non-nut consumers. Nut consumers had lower prevalence of inadequate micronutrient intakes, but also higher CQI, higher FQI, and better scores of adherence to the Mediterranean diet (Mediterranean diet score, MDS). Conclusions: nut consumers had better nutrient adequacy, diet quality, and adherence to the MedDiet than those non-nut consumers.

Education and Income Levels are Associated With Energy and Micronutrient Intake.

Introduction: According to the literature, education and income are determinants factors of diet quality and consequently of micronutrient intake. However, this association is still little known among adults who live in middle-income countries. Objective: To estimate energy and micronutrients intake by men and women living in a capital city in southern Brazil, according to education and income levels, and to identify prevalence of inadequate micronutrient intake according also to education and income levels. Method: This is a second wave cross-sectional analysis of a population-based longitudinal study, the EpiFloripa Adultos, including 1,222 individuals of 22-63 years. Data on food consumption were obtained through applying two 24-hour dietary recalls, and the prevalence of inadequate micronutrient intake, following the recommendations of the Institute of Medicine and from the National Research Council. Results: A tendency of increased intake with an increase in income (calcium, vitamins C, E) and education levels (calcium, vitamins A, C, D) was observed for most of the micronutrients analyzed (p<0.05 in all cases); still, a prevalence of inadequacy according to Estimated Average Requirement (EAR) between 85.5-100% in intake of vitamins A, D and E were found for the whole sample. Iron inadequate intake was associated with education level and among women less than 50 years of age (p=0.018). Conclusion: The results showed an influence of the education and income levels on micronutrient intake, point to the need of daily food consumption, of minimally processed and in natura foods (as fruits, vegetables, whole grains, milk and its derivatives) as a means to reduce the encountered inadequacies.

Pre-pregnancy dietary micronutrient adequacy is associated with lower risk of developing gestational diabetes in Australian women

Evidence on pre-pregnancy dietary micronutrient intake in relation to gestational diabetes (GDM) development is limited. Therefore, we examined the prevalence of inadequate micronutrient intake before pregnancy and the association between pre-pregnancy dietary micronutrient adequacy, i.e. meeting micronutrient intake recommendations for a range of micronutrients, and risk of developing GDM in an Australian population. We hypothesized that women with an overall higher micronutrient adequacy would have a lower risk of developing GDM. We used data from the prospective Australian Longitudinal Study on Women's Health cohort, in which 3607 women, aged 25–30 years at baseline in 2003 and without diabetes, were followed-up until 2015. Diet was assessed with a validated 101-item food frequency questionnaire. The Micronutrient Adequacy Ratio (MAR) was calculated as the micronutrient intake divided by its recommended dietary intake averaged over 13 micronutrients. Multivariable regression models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (95% CI). In 6263 pregnancies, 285 cases of GDM were documented (4.6%). High prevalences of inadequate dietary micronutrient intake were observed for calcium (47.9%), folate (80.8%), magnesium (52.5%), potassium (63.8%) and vitamin E (78.6%), indicating suboptimal pre-pregnancy micronutrient intakes. Inadequate intakes of individual micronutrients were not associated with risk of developing GDM. However, women in the highest quartile of the MAR had a 39% lower risk of developing GDM compared to women in the lowest quartile (RR 0.61, 95% CI 0.43–0.86, p for trend 0.01). These results highlight the importance of adequate pre-pregnancy micronutrient intake.

Prevalence of inadequate micronutrient intakes of Canadian long-term care residents.

This study determines the prevalence of inadequate micronutrient intakes consumed by long-term care (LTC) residents. This cross-sectional study was completed in thirty-two LTC homes in four Canadian provinces. Weighed and estimated food and beverage intake were collected over 3 non-consecutive days from 632 randomly selected residents. Nutrient intakes were adjusted for intra-individual variation and compared with the Dietary Reference Intakes. Proportion of participants, stratified by sex and use of modified (MTF) or regular texture foods, with intakes below the Estimated Average Requirement (EAR) or Adequate Intake (AI), were identified. Numbers of participants that met these adequacy values with use of micronutrient supplements was determined. Mean age of males (n 197) was 85·2 (sd 7·6) years and females (n 435) was 87·4 (sd 7·8) years. In all, 33 % consumed MTF; 78·2 % (males) and 76·1 % (females) took at least one micronutrient pill. Participants on a MTF had lower intake for some nutrients (males=4; females=8), but also consumed a few nutrients in larger amounts than regular texture consumers (males=4; females =1). More than 50 % of participants in both sexes and texture groups consumed inadequate amounts of folate, vitamins B6, Ca, Mg and Zn (males only), with >90 % consuming amounts below the EAR/AI for vitamin D, E, K, Mg (males only) and K. Vitamin D supplements resolved inadequate intakes for 50-70 % of participants. High proportions of LTC residents have intakes for nine of twenty nutrients examined below the EAR or AI. Strategies to improve intake specific to these nutrients are needed.

Global trends in dietary micronutrient supplies and estimated prevalence of inadequate intakes.

Understanding dietary patterns is vital to reducing the number of people experiencing hunger (about 795 million), micronutrient deficiencies (2 billion), and overweight or obesity (2.1 billion). We characterize global trends in dietary quality by estimating micronutrient density of the food supply, prevalence of inadequate intake of 14 micronutrients, and average prevalence of inadequate intake of these micronutrients for all countries between 1961 and 2011. Over this 50-year period, the estimated prevalence of inadequate intakes of micronutrients has declined in all regions due to increased total production of food and/or micronutrient density. This decline has been particularly strong in East and Southeast Asia and weaker in South Asia and sub-Saharan Africa. Sub-Saharan Africa is the only region where dietary micronutrient density has declined over this 50-year period. At the global level, micronutrients with the lowest levels of adequate estimated intake are calcium, iron, vitamin A, and zinc, but there are strong differences between countries and regions. Fortification has reduced the estimated prevalence of inadequate micronutrient intakes in all low-income regions, except South Asia. The food supply in many countries is still far below energy requirements, which suggests a need to increase the availability and accessibility of nutritious foods. Countries where the food energy supply is adequate show a very large variation in dietary quality, and in many of these countries people would benefit from more diverse diets with a greater proportion of micronutrient-dense foods. Dietary quality can be improved through fortification, biofortification, and agricultural diversification, as well as efforts to improve access to and use of micronutrient-dense foods and nutritional knowledge. Reducing poverty and increasing education, especially of women, are integral to sustainably addressing malnutrition.

Low prevalence of inadequate micronutrient intake in young children in the south of Brazil: a new perspective.

In Brazil, children's eating patterns have been characterised by an increased consumption of ultra-processed foods that are fortified. Our aims were to (1) estimate the prevalence of inadequate micronutrient intake among children from low-income families and (2) to assess micronutrient intake from fortified foods. We carried out a cross-sectional study from a randomised field trial conducted at healthcare centres in Porto Alegre, Brazil, with 446 mother-child pairs, with the children aged 2-3 years. Dietary data were assessed using two 24-h recalls. The prevalence of inadequacy for six micronutrients was estimated using the proportion of individuals with intakes below the estimated average requirement (EAR). Micronutrient intakes from fortified foods were evaluated using EAR and upper tolerable level (UL). Healthy foods consumption was below the recommendations, except for beans, and 88·1 % of the children consumed ultra-processed foods. A low prevalence of inadequate micronutrient intake was observed for Fe (1·2 %), vitamin C (4·7 %), vitamin A (5·2 %), Ca (11·4 %) and folate (15·2 %). None of the children had intakes less than the EAR for Zn. Fortified foods contributed between 11·3 and 38·3 % to micronutrient intakes, and 43·0 % of the children met the EAR for Fe, 13·9 % for vitamin C and 12·3 % for Zn using fortified foods only. In addition, 4·0 % of the children exceeded the UL for vitamin A, 3·1 % for Zn, 1·1 % for folic acid and 0·2 % for Fe. These results highlight a low prevalence of inadequate micronutrient intakes among children and suggest that such a group could be at risk of excessive micronutrient intakes provided by ultra-processed foods.