Total Usual Intakes Research Articles

P14-080-23 Dietary Trends in Total Usual Intake of Vitamin C Using NHANES 1999–2018: A Curtain-Raiser to Dietary Intake Visualizers in Nutrition Research

P14-080-23 Dietary Trends in Total Usual Intake of Vitamin C Using NHANES 1999–2018: A Curtain-Raiser to Dietary Intake Visualizers in Nutrition Research

Inadequate Iodine Intake in Mothers of Young Children in Innlandet County, Norway

BackgroundIodine has an essential role in child growth and brain development. Thus, sufficient iodine intake is particularly important in women of childbearing age and lactating women. ObjectivesThis cross-sectional study aimed to describe iodine intake in a large random sample of mothers of young children (aged ≤2 y) living in Innlandet County, Norway. MethodsFrom November 2020 to October 2021, 355 mother–child pairs were recruited from public health care centers. Dietary data were obtained using two 24-h dietary recalls (24-HRs) per woman and an electronic FFQ. The Multiple Source Method was used to estimate the usual iodine intake from the 24-HR assessment. ResultsBased on the 24-HRs, the median (P25, P75) usual iodine intake from food was 117 μg/d (88, 153) in nonlactating women and 129 μg/d (95, 176) in lactating women. The median (P25, P75) total usual iodine intake (from food combined with supplements) was 141 μg/d (97, 185) in nonlactating women and 153 μg/d (107, 227) in lactating women. Based on the 24-HRs, 62% of the women had a total iodine intake below the recommendations (150 μg/d in nonlactating women and 200 μg/d in lactating women), and 23% of them had an iodine intake below the average requirement (100 μg/d). The reported use of iodine-containing supplements was 21.4% in nonlactating women and 28.9% in lactating women. In regular users of iodine-containing supplements (n = 63), supplements contributed to an average of 172 μg/d of iodine. Among regular iodine supplement users, 81% reached the recommendations compared with 26% of nonsupplement users (n = 237). The iodine intake estimated by FFQ was substantially higher than that estimated by 24-HRs. ConclusionsMaternal iodine intake in Innlandet County was inadequate. This study confirms the need for action to improve iodine intake in Norway, particularly among women of childbearing age.

Total Usual Nutrient Intakes and Nutritional Status of United Arab Emirates Children (4 Years-12.9 Years): Findings from the Kids Nutrition and Health Survey (KNHS) 2021.

This study aims at investigating the anthropometric status and food consumption patterns of children in the United Arab Emirates (UAE) and assessing their adherence to nutrient and dietary recommendations. It is a population-based cross-sectional survey of 690 children (4-12.9 years), from 3 major Emirates. Socio-demographic and anthropometric characteristics were collected. Dietary intakes were assessed using the 24-hour recall approach. Of the total sample, 4% were stunted, 8% were wasted and 28% were overweight/obese. A third of participating children consumed above the Estimated Energy Requirement, while the majority's intakes carbohydrate, total fat, and protein were within the recommendations; whereas over 70% and 90% of participants consumed above the WHO daily limits of free sugars and saturated fats, respectively. Inadequate intakes of linoleic acid (36% of children), alpha-linolenic acid (91%) and dietary fiber (100%) were observed. All children failed to meet the recommendation for vitamin D and considerable proportions had inadequate intakes of vitamin A, calcium, zinc, folate, and magnesium. Compared with the American Heart Association/American Academy of Pediatrics recommendations, low dietary adherence was noted for fruits (9%), vegetables (4%), and milk/dairy (14%). These findings may be used in the development of nutritional policies aimed at improving the diets of children in the UAE.

Characterization of Choline Nutriture among Adults and Children with Phenylketonuria.

Choline is an essential nutrient for brain development and function that is attained through high-protein foods, which are limited in the phenylalanine-restricted diet of people with phenylketonuria (PKU). This study compared choline consumption among individuals with PKU to a reference sample from the National Health and Nutrition Examination Survey (NHANES), and identified treatment and diet-related factors that may modulate choline needs. Participants were individuals with PKU (n = 120, 4–61 years) managed with dietary therapy alone (n = 49), sapropterin dihydrochloride for ≥1 year (n = 38), or pegvaliase for ≥1 year with no medical food (n = 33). NHANES participants were not pregnant or nursing and came from the 2015–2018 cycles (n = 10,681, 4–70 years). Dietary intake data were used to estimate total usual intake distributions for choline, and mean probability of adequacy (MPA) was calculated as a summary index of nutrient adequacy for four methyl-donor/co-factor nutrients that impact choline utilization (folate, vitamin B12, vitamin B6, and methionine). Only 10.8% (SE: 2.98) of the total PKU sample (14.7% [SE: 4.03] of children; 6.8% [SE: 2.89] of adults) achieved the adequate intake (AI) for choline, while 12.2% (SE:0.79) of the NHANES sample met the recommended level. Adults receiving pegvaliase were the most likely to exceed the AI for choline (14.82% [SE: 4.48]), while adults who were on diet therapy alone were the least likely (5.59% [SE: 2.95]). Without fortified medical foods, individuals on diet therapy and sapropterin would not be able to achieve the AI, and MPA for other methyl donor/co-factor nutrients would be reduced. More frequent monitoring of choline intake and increased choline fortification of medical foods could benefit this population.

Total Usual Nutrient Intakes and Nutritional Status of United Arab Emirates Children (

ABSTRACTBackgroundThe transition from a predominantly milk-based diet to a diverse family diet is a window of opportunity for optimal child growth and development.ObjectivesThe study aims to examine the nutritional status and food-consumption patterns of children under 4 y of age in the United Arab Emirates (UAE) and their adherence to nutrient and dietary recommendations.MethodsA population-based cross-sectional survey of 525 children aged 0–47.9 mo was conducted in 3 major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometric measurements were obtained, and dietary assessment was conducted using the 24-h dietary recall approach. Usual intakes of energy, macronutrient, and micronutrients, including from supplements, were assessed using PC-SIDE software. Adherence to food-group recommendations was evaluated based on the American Heart Association/American Academy of Pediatrics dietary guidelines.ResultsAmong 0–4-y-old children, 10% were stunted, 6% were wasted, 17% were at risk of overweight, 5% were overweight, and 3% were obese. The contribution of sweets and sugar sweetened beverages to energy intake increased from 5% in 6–11.9-mo-old children to 17% in 36–47.9-mo-old children. Compared with dietary guidelines, the lowest adherence was for fruit (13–18%) and vegetables (7–12%), while protein was within the recommendations, and 92% and 89% of children (aged 24 to 35.9 mo and 36 to 47.9 mo, respectively) had high intakes of saturated fat. Almost all toddlers failed to meet the Adequate Intake for fiber. The proportions of children exceeding the free-sugar upper limit increased from 10.6% in infants (0–5.9 mo) to 56.7% in toddlers (12– 23.9 mo). Micronutrient inadequacies were observed, particularly for calcium, zinc, folate, and vitamins A and D.ConclusionsThis study suggests a triple burden of malnutrition among infants and young children in the UAE. Results call for national nutrition intervention strategies aimed at improving dietary quality in the pediatric population.

Adequacy of total usual micronutrient intakes among pregnant women in the United States by level of dairy consumption, NHANES 2003-2016.

Background: Dairy products are a rich source of nutrients of public health concern, though most women do not meet the recommended intake of 3 cup-eq/day. Aim: The objective of this analysis was to examine micronutrient adequacy among pregnant women in the US by level of dairy consumption. Methods: Pregnant women (n = 791) ages 20-44 years in NHANES 2003-2016 were categorized by level of dairy consumption (<1, 1 to <2, 2 to <3, and ≥3 cup-eq/day). Usual micronutrient intakes and prevalence of intakes below the Estimated Average Requirement (EAR) or above the Adequate Intake level (AI) were calculated from food alone and food plus dietary supplements using the National Cancer Institute method. Diet quality was assessed with the Healthy Eating Index 2015 (HEI-2015). Results: Pregnant women consuming ≥3 cup-eq/day of dairy were more likely to meet the potassium AI than women consuming lower levels. Compared to women consuming ≥3 cup-eq/day of dairy, women consuming <1 or 1 to <2 cup-eq/day were more likely to have inadequate intake of vitamin D, magnesium, zinc, and vitamin A from foods plus supplements. Compared to women consuming ≥3 cup-eq/day of dairy, women consuming <1 cup-eq/day were more likely to have inadequate intake of calcium and riboflavin. The median urinary iodine concentration (UIC) among pregnant women consuming ≥3 cup-eq/day of dairy was 220 ng/mL compared with median UICs of 98-135 mg/mL among women consuming the lowest levels. Pregnant women consuming ≥3 cup-eq/day of dairy had the highest intake of sodium (mg/day) and saturated fat intake evaluated as a HEI-2015 component. Conclusions: Consumption of recommended levels of dairy products may help pregnant women achieve adequate intakes of select micronutrients.

Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011–2016

Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown. The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children. Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls. Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls. Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.

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

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

Examining the Validity of the Total Nutrient Index for Assessing Intakes of Nutrients From Foods, Beverages, and Dietary Supplements

ObjectivesTo develop and validate the total nutrient index (TNI), a nutrient-based scoring system that assesses nutrient exposures from foods/beverages and dietary supplements (DS). MethodsThe TNI includes 8 shortfall micronutrients identified in the Dietary Guidelines for Americans: calcium, magnesium, potassium, choline, and vitamins A, C, D, E. Predicted usual intake is expressed as a percentage of the appropriate Recommended Dietary Allowance or Adequate Intake and truncated at 100 to compute component scores. The average of the component scores yields the total TNI score (range 0–100). Usual intakes from foods/beverages and DS of U.S. adults (≥19y) were estimated using a multivariate extension of the National Cancer Institute method. Data sources were two 24-hour recalls and a questionnaire/in-home inventory on DS use, collected in the 2011–2014 National Health and Nutrition Examination Survey (NHANES) (n = 9,954). Concurrent criterion validity was evaluated by comparing TNI scores between subpopulations with known differences in diet quality and by correlating component scores for vitamins A, C, D, and E with biomarker data. Due to data availability, biomarker analysis for vitamins A, C, and E used data from 2003–2006 NHANES (N = 8,861). Convergent validity was determined by correlating the TNI with the Healthy Eating Index (HEI-2015). ResultsThe estimated mean total TNI score was 75.4; the same index calculated using foods/beverages only was 69.0. The TNI scores were significantly different (p < 0.001) for DS-users (83.5) vs. non-users (67.1), non-smokers (76.8) vs. smokers (70.3), and by food security status (food-secure: 76.6 vs. food-insecure: 69.1). The Pearson correlation of the TNI and HEI-2015 total score was 0.48, suggesting that the TNI captures dimensions of nutrient intake that are correlated with but distinct from those captured with the HEI-2015. Correlations of component scores with the available biomarkers ranged from 0.12 (α-tocopherol) to 0.36 (25(OH)D) and were all < 0.10 when DS were not included. ConclusionsThe TNI identifies total usual intake of shortfall nutrients and extends existing measures of diet quality by including nutrients obtained from DS. Tests of validity suggest the TNI is an effective tool in assessing total nutrient exposures of shortfall nutrients among U.S. adults. Funding SourcesNational Institutes of Health.

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.

Impacts of an egg complementary feeding trial on energy intake and dietary diversity in Malawi.

Complementary feeding diets in low‐ and middle‐income countries are generally inadequate to meet requirements for growth and development. Food‐based interventions may prevent nutrient inadequacies provided that they do not displace other nutrient‐rich foods. We conducted a randomized controlled trial in rural Malawi in which 660 children aged 6 to 9 months were provided an egg a day for 6 months or assigned to a control group. Dietary intake of complementary foods and drinks was assessed at baseline, 3‐month midline and 6‐month endline visits using a tablet‐based multipass 24‐h recall. Up to two repeat recalls were collected at each time point in a subsample of 100 children per treatment group. At midline and endline, usual energy intake from eggs was about 30 kcal/day higher in the egg group compared with controls (p < 0.0001). Compared with controls, children in the egg group were over nine times more likely to consume eggs at midline and endline. There was a comparable, but nonsignificant, greater total usual energy intake from complementary foods of 30 kcal/day at midline (p = 0.128) and 36 kcal/day at endline (p = 0.087). There also was a displacement of 7 kcal/day in legumes and nuts in children at endline (p = 0.059). At midline and endline, more than 80% of children in the egg group consumed a minimally diverse diet compared with 53% at midline and 60% at endline in the control group. This study illustrates that mothers in the egg group fed eggs to young children on a regular basis without substantial displacement of other complementary foods.

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

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

Providing Infants with the Best Start in Life: Identification of Nutrient Gaps in Women of Childbearing Age in the United States

Abstract Objectives Folate, iron, iodine, DHA, choline, zinc, vitamin A, D, B6 and B12 are key nutrients for supporting the baby's neurodevelopment from conception, throughout pregnancy and for the first two years of life. The objective of this study is to determine total estimated usual nutrient intakes and to identify nutrient gaps by comparing the intakes to corresponding Estimated Average Requirement (EAR) or Adequate Intake (AI), as well as the Tolerable Upper Intake Level (UL) in women of childbearing age (15–44 years). Methods Usual intake of nutrients from food and food + supplements were estimated using the National Cancer Institute method from 2 valid 24-hr dietary recalls among 4134 women aged 15–44 years (further grouped into 15–30 and 31–44 years) in NHANES 2011–16, a cross-sectional nationally representative health examination survey. Results The mean age of the sample population was 29.2 ± 0.3 years, with a majority non-Hispanic white (54.9%) and high income (55%, PIR &amp;gt; 1.85). The percentage of women that had usual intake from food less than the EAR was as follows (percentage for 15–30 year old followed by percentage for 31–44 year old): vitamin D (&amp;gt;97%, &amp;gt; 97%), vitamin E (92% ± 1.0%, 88% ± 1.4%), magnesium (62% ± 1.9%, 44% ± 1.8%), vitamin A (50% ± 2.3%, 44% ± 2.2%), calcium (49% ± 1.6%, 44% ± 1.9%), vitamin C (47% ± 2.2%, 46% ± 2.2%). The percentage of women that had total usual intake below the AI was approximately (percentage for 15–30 year old followed by percentage for 31–44 year old): choline (96%, 94%), dietary fiber (96%, 92%), potassium (66%, 68%), vitamin K (43%, 43%). Conclusions A significant percentage of the women of childbearing age are not meeting the dietary recommendations for vitamin A, D, E, K, C, magnesium, calcium, choline, potassium and dietary fiber. The influence of which can be substantial; when infants are not given the best start in life, our society is directly impacted. Funding Sources This study was funded by Pharmavite LLC.

Older adults with obesity have higher risks of some micronutrient inadequacies and lower overall dietary quality compared to peers with a healthy weight, National Health and Nutrition Examination Surveys (NHANES), 2011-2014.

To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight. Cross-sectional study. Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011-2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score. Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size. A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression. Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.

Adequacy of Total Usual Nutrient Intakes from Foods and Supplements Among Pregnant Women in the United States by Level of Dairy Consumption, NHANES 2003–2016

Abstract Objectives Dairy products are a rich source of many nutrients including calcium, vitamins A and D, and potassium; these micronutrients are among the nutrients underconsumed by pregnant women. The objective of this analysis was to examine nutrient intake adequacy from foods (including beverages) and dietary supplements among pregnant women in the US by level of dairy consumption. Methods Using data from pregnant women (n = 806) ages 20–44 years in the combined NHANES 2003–2016, usual intakes (UI) of micronutrients from food and dietary supplement sources were estimated by level of total reported dairy product consumption categorized as &amp;lt;1 (n = 244, 31%), 1 to &amp;lt;2 (n = 211, 28%), 2 to &amp;lt;3 (n = 144, 19%), and ≥3 (n = 207, 22%) cup equivalents per day (cup-eq/d). The Dietary Guidelines for Americans recommendation for dairy product consumption is 3 cup-eq/d. Usual intakes and prevalence of intakes below the Estimated Average Requirement (EAR) for underconsumed nutrients (e.g., magnesium and vitamin A) and nutrients of public health concern (e.g., calcium, potassium, and vitamin D) were calculated using the National Cancer Institute (NCI) method. Statistical significance was set at P &amp;lt; 0.05. Results Mean consumption of dairy products among pregnant women was 2.0 ± 0.08 cup-eq/d, with 78% of pregnant women consuming less than the recommended 3 cup-eq/d. Compared to women consuming ≥3 cup-eq/d, women consuming &amp;lt;1 or 1 to &amp;lt;2 cup-eq/d of dairy products were more likely to have inadequate intakes of vitamin D (22% vs 56% and 22% vs 51%, respectively) and potassium (31% vs 81% and 31% vs 71%, respectively). Compared to women consuming ≥3 cup-eq/d of dairy products, women consuming &amp;lt;1 cup-eq/d were more likely to have inadequate intakes of calcium (&amp;lt;3% vs 43%). Pregnant women consuming ≥3 cup-eq/d of dairy products were less likely to have inadequate intakes of vitamin A and magnesium compared to women consuming the lowest levels of dairy intake. Conclusions Consumption of dairy products among pregnant women is associated with increased prevalence of adequate intakes of select underconsumed micronutrients. Funding Sources Dairy Management Inc.

Calcium Intake from Food and Supplemental Sources Decreased in the Canadian Population from 2004 to 2015

In light of the publications (2008-2014) linking calcium intake, mainly from supplements, to the elevated risk of cardiovascular events, there is a need to determine if there have been any changes in usual intakes of calcium among Canadians. We aimed to examine changes in dietary and total usual intake of calcium among Canadians aged ≥1 y over the period 2004-2015. We used nutrition data from 2 nationally representative surveys conducted in 2004 and 2015 (CCHS 2004 Cycle 2.2 and CCHS-Nutrition 2015). This study included all the Canadians across 10 provinces, and the analyses were performed across different age/sex groups. We used the National Cancer Institute (NCI) method to estimate the usual intake of calcium and the prevalence of calcium inadequacy. Multiple logistic regression was performed to assess the relation between supplement uses and sociodemographic variables. From 2004 to 2015, the usual intake of calcium from food sources significantly decreased in calcium supplement nonusers (from 872±18.2mg/d to 754±18.0mg/d), but not in calcium supplement users. The contribution of calcium from the Milk and alternatives food group significantly decreased by 7.5% and 6.1% in calcium supplement users and nonusers, respectively. The prevalence of calcium supplement use significantly decreased from 2004 to 2015 in the Canadian population, from 27.5% to 22.0%. During this time, the percentage contribution of calcium from supplemental sources significantly decreased among Canadians, especially women. The prevalence of calcium inadequacy increased from 58.0% to 68.0% in supplement nonusers; however, among users of calcium supplements, the prevalence of calcium inadequacy remained at ∼31%. Calcium intake from both food and supplemental sources decreased in the Canadian population over an 11-y period, which must be addressed by policy-makers in their efforts to decrease the high prevalence of calcium inadequacy.

Vitamin D Intake from Supplemental Sources but Not from Food Sources Has Increased in the Canadian Population Over Time

Evidence is lacking to determine whether there have been any changes in dietary or total usual intakes of vitamin D among Canadians, in the light of recent evidence of beneficial health effects beyond bone. We aimed to examine trends in dietary and total usual intake of vitamin D among Canadians aged ≥1 y. This study used nationally representative nutrition data from the Canadian Community Health Survey Cycle 2.2 (CCHS 2004) and CCHS Nutrition in 2015. Dietary intake data were collected with use of two 24-h dietary recalls and dietary supplement use was determined by questionnaire. The National Cancer Institute method was used to estimate the usual intake of vitamin D as well as the prevalence of vitamin D inadequacy among Canadians aged ≥1 y. From 2004 to 2015, the usual intake of vitamin D from food significantly decreased (P<0.05) by 1μg/d only in vitamin D supplement nonusers. The contribution of Milk and Alternatives food group (i.e., fluid milk, fortified soy beverages, powdered milk, and other milk alternatives) to dietary vitamin D intake significantly decreased (P<0.05) in both supplement users (by 7.1%) and nonusers (by 5.8%). Prevalence of vitamin D supplement use and percentage contribution of vitamin D from supplemental sources significantly increased (P<0.05) by 5.0% and 14.9%, respectively, from 2004 to 2015. Total usual intake of vitamin D (food+supplement) significantly increased (P<0.05) from 15.1±0.3μg/d in 2004 to 31.5±1.8μg/d in 2015 in vitamin D supplement users. In contrast to vitamin D supplement nonusers, the prevalence of vitamin D inadequacy significantly decreased (P<0.05) from 20.6% to 14.1% among users of vitamin D supplements. The prevalence of vitamin D supplement use and the percentage contribution of vitamin D from supplemental sources has increased in the Canadian population over an 11-y period.

Multivitamins and Nutritional Adequacy in Middle-Aged to Older Americans by Obesity Status

AbstractMultivitamins are the most commonly consumed dietary supplement in the United States and worldwide. Micronutrient insufficiency and clinical deficiency are more common in middle-aged to older adults, and multivitamin use has been shown to improve status in this population. This analysis aimed to assess contributions of sporadic and consistent multivitamin use to total usual micronutrient intakes and associated nutritional biomarkers among middle-aged to older U.S. adults age 351 years, stratified by obesity status. Self-reported dietary intake and laboratory measures from the National Health and Nutrition Examination Survey were used in these analyses. The National Cancer Institute method was used to assess usual intakes of 18 micronutrients. Compared with food alone, multivitamin use was associated with a lower prevalence of inadequacies and improved nutritional biomarker status for folate, iodine, selenium, and vitamins B6, B12, and D. Consistent use decreased the prevalence of inadequacy for most micronutrients assessed, except for those micronutrients typically not found (or in miniscule amounts) in standard multivitamin products. In addition to a lower prevalence of inadequacy for many micronutrients associated with consistent use of multivitamins, sporadic use decreased the prevalence of inadequacy for a greater number of micronutrients in obese versus nonobese individuals. Multivitamin use (sporadic and consistent) also increased the proportion of individuals who exceeded the tolerable upper intake level for folic acid to 8–10%. Nutritional biomarker data indicate that obese individuals may be at greater risk of clinical deficiency in vitamins B6and D. Use of gender- and age-specific multivitamins may serve as a practical means to increase micronutrient status and decrease prevalences of clinical deficiency in the middle-aged to older population, particularly in those who are obese.

Total Usual Micronutrient Intakes Compared to the Dietary Reference Intakes among U.S. Adults by Food Security Status.

This study examined total usual micronutrient intakes from foods, beverages, and dietary supplements (DS) compared to the Dietary Reference Intakes among U.S. adults (≥19 years) by sex and food security status using NHANES 2011–2014 data (n = 9954). DS data were collected via an in-home interview; the NCI method was used to estimate distributions of total usual intakes from two 24 h recalls for food and beverages, after which DS were added. Food security status was categorized using the USDA Household Food Security Survey Module. Adults living in food insecure households had a higher prevalence of risk of inadequacy among both men and women for magnesium, potassium, vitamins A, B6, B12, C, D, E, and K; similar findings were apparent for phosphorous, selenium, and zinc in men alone. Meanwhile, no differences in the prevalence of risk for inadequacy were observed for calcium, iron (examined in men only), choline, or folate by food security status. Some DS users, especially food secure adults, had total usual intakes that exceeded the Tolerable Upper Intake Level (UL) for folic acid, vitamin D, calcium, and iron. In conclusion, while DS can be helpful in meeting nutrient requirements for adults for some micronutrients, potential excess may also be of concern for certain micronutrients among supplement users. In general, food insecure adults have higher risk for micronutrient inadequacy than food secure adults.

Multivitamins and Nutritional Adequacy in Middle-Aged to Older Americans by Obesity Status

Multivitamins are the most commonly consumed dietary supplement in the United States and worldwide. Micronutrient insufficiency and clinical deficiency are more common in middle-aged to older adults, and multivitamin use has been shown to improve status in this population. This analysis aimed to assess contributions of sporadic and consistent multivitamin use to total usual micronutrient intakes and associated nutritional biomarkers among middle-aged to older US adults age ≥51 years, stratified by obesity status. Self-reported dietary intake and laboratory measures from the National Health and Nutrition Examination Survey were used in these analyses. The National Cancer Institute method was used to assess usual intakes of 18 micronutrients. Compared with food alone, multivitamin use was associated with a lower prevalence of inadequacies and improved nutritional biomarker status for folate, iodine, selenium, and vitamins B6, B12, and D. Consistent use decreased the prevalence of inadequacy for most micronutrients assessed, except for those micronutrients typically not found (or in miniscule amounts) in standard multivitamin products. In addition to a lower prevalence of inadequacy for many micronutrients associated with consistent use of multivitamins, sporadic use decreased the prevalence of inadequacy for a greater number of micronutrients in obese versus nonobese individuals. Multivitamin use (sporadic and consistent) also increased the proportion of individuals who exceeded the tolerable upper intake level for folic acid to 8%–10%. Nutritional biomarker data indicate that obese individuals may be at greater risk of clinical deficiency in vitamins B6 and D. Use of gender- and age-specific multivitamins may serve as a practical means to increase micronutrient status and decrease prevalences of clinical deficiency in the middle-aged to older population, particularly in those who are obese.