Total Usual Intakes Research Articles

Estimation of Total Usual Dietary Intakes of Pregnant Women in the United States

Nutrition during pregnancy is a critical dimension not only for women's health but also for the lifelong health of the offspring. Very limited national data exist on the usual dietary intakes of pregnant women. To estimate total usual nutrient intakes (from foods and dietary supplements) and the population prevalence of meeting or exceeding the National Academies of Sciences, Engineering, and Medicine Dietary Reference Intake recommendations among pregnant US women. A cross-sectional analysis was performed of a nationally representative sample of 1003 pregnant US women aged 20 to 40 years from the 2001-2014 National Health and Nutrition Examination Survey. Usual dietary intakes assessed by two 24-hour dietary recalls (including dietary supplements) adjusted for within-person variation using the National Cancer Institute method. The proportion of women at risk of inadequate dietary intake as determined by the Estimated Average Requirement, the proportion of women assumed to have adequate dietary intake as determined by the Adequate Intake, and the proportion of women at risk of excess dietary intake as determined by the Tolerable Upper Intake Level. Demographic differences between pregnant and nonpregnant women were compared with t tests. As representative of the US population, this sample of 1003 pregnant women had a mean (SE) age of 28.0 (0.3) years, was predominantly non-Hispanic white (mean [SE], 54.5% [3.1%]), and was at above 185% of the income to poverty ratio (mean [SE], 56.8% [3.0%]). Most pregnant women used a dietary supplement (mean [SE], 69.8% [2.3%]). A total of 10% or more of pregnant women had a total usual intake that is less than the Estimated Average Requirement for magnesium (mean [SE], 47.5% [2.8%]), vitamin D (mean [SE], 46.4% [2.7%]), vitamin E (mean [SE], 43.3% [2.7%]), iron (mean [SE], 36.2% [2.8%]), vitamin A (mean [SE], 15.5% [2.1%]), folate (mean [SE], 16.4% [1.6%]), calcium (mean [SE], 12.9% [2.4%]), vitamin C (mean [SE], 11.5% [1.9%]), vitamin B6 (mean [SE], 11.5% [1.5%]), and zinc (mean [SE], 10.9% [1.9%]). Some pregnant women exceeded the Adequate Intake for potassium (mean [SE], 41.7% [2.9%]), choline (mean [SE], 7.9% [3.2%]), and vitamin K (mean [SE], 47.9% [4.3%]). Most women exceeded the Tolerable Upper Intake Level for sodium (mean [SE], 95.0% [2.2%]), and some women exceeded the Tolerable Upper Intake Level of folic acid (mean [SE], 33.4% [2.8%]), iron (mean [SE], 27.9% [2.8%]), calcium (mean [SE], 3.0% [0.8%]), and zinc (mean [SE], 7.1% [1.6%]). For iron, the prevalence of an at-risk intake from foods alone was lower among women who used supplements (mean [SE], 80.3% [4.3%]) than those who did not use supplements (mean [SE], 95.3% [7.3%]); however, supplement use increased the risk of excessive iron and folic acid intakes given the amounts that are being consumed from supplemental products. This study suggests that a significant number of pregnant women are not meeting recommendations for vitamins D, C, A, B6, K, and E, as well as folate, choline, iron, calcium, potassium, magnesium, and zinc even with the use of dietary supplements. Almost all pregnant women in this study were at risk of excessive consumption of sodium, and many were at risk of excessive consumption of folic acid and iron. Improved dietary guidance to help pregnant women meet but not exceed dietary recommendations is warranted.

Dietary Supplements Contributed Substantially to Total Intakes and Nutritional Adequacy of Several Micronutrients Among U.S. Adults, NHANES 2011–2014 (OR14-07-19)

ObjectivesTo estimate total mean usual micronutrient intakes (inclusive of dietary supplements (DS)), Dietary Reference Intakes (DRI) adherence, and the % contribution of DS to total usual micronutrient intakes for U.S. adults (≥19y) using data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES, n = 9474), by sex, age, and race and Hispanic origin groupings. MethodsDietary data were collected using two 24-hour recalls; DS data was collected via an in-home 30-day questionnaire that ascertained participants’ usage in the past 30 days. The National Cancer Institute Method was used to estimate mean total usual micronutrient intakes and the proportion of the population complying with DRI by population subgroups: sex, age, and race and Hispanic origin. ResultsDS contributed substantially to meeting the DRI recommendations for several key nutrients, including calcium, magnesium, folate, zinc, and vitamins C, D, B6, and K in both men and women. However, approximately half of U.S. adults still failed to meet the estimated average requirement (EAR) for magnesium (45%), and vitamins C (35%), K (45%), and D (63%), even with the inclusion of DS. The proportion of total usual intakes < EAR was significantly higher in men than women for magnesium (46 v 42%) and vitamins C (39 v 32%), and D (66 v 59%). In both men and women, total intakes of folate, zinc, and vitamins A, D, and B12 increased with age. Vitamin D from DS contributed the most towards total intake for most sex and age groups, with the largest contribution being in older women (84%). Non-Hispanic (NH) Blacks and Hispanics had significantly lower total intake of vitamin D than those of NH Whites and Asians, while NH Whites and Hispanics had significantly higher total intakes of calcium than their NH Black and Asian counterparts. ConclusionsAdherence to DRI recommendations for nutrient intake differs significantly by sex, race and other demographic characteristics. Dietary supplements substantially contribute to total intakes for several micronutrients among users; however, many population subgroups continue to be at risk for inadequacy for key nutrients. Funding SourcesThis work was supported through the National Institutes of Health.

Total Usual Dietary Intakes of Pregnant Women in the United States, 2001-2014 (FS08-01-19)

ObjectivesNutrition during pregnancy is a critical dimension not only for women’s heath, but also for the offspring’s lifelong health. Very limited national data exist on the usual dietary intakes of pregnant women. The objective of this study was to estimate total usual nutrient intakes (from foods and dietary supplements) of pregnant women in the U.S. MethodsCross-sectional analysis of a nationally-representative sample of pregnant U.S. women, ages 20-40 years (n = 1,003) from NHANES 2001-2014. Total usual dietary intakes were estimated using the National Cancer Institute (NCI) method to adjust 2, 24-hour dietary recalls for within-person variation. Adherence with the Dietary Reference Intakes were used to assess the proportion at risk of inadequacy by the Estimated Average Requirement (%< EAR), assumed to be adequate by the Adequate Intake (% >AI), and at risk of excess by the Tolerable Upper Intake Level (% >UL). ResultsAbout 70% of pregnant women use a dietary supplement. Less than 5% of pregnant women have usual diets that are at risk for inadequate intakes of riboflavin (3%), niacin (1%), vitamin B12 (1%), iron (2%), phosphorus (< 0.5%), and selenium (< 0.5%). More pregnant women have usual intakes < EAR for vitamins A (15%), B6 (11%), folate (16%), C (11%), D (46%), E (43%), and minerals including copper (5%), calcium (13%), magnesium (47%) and zinc (11%). Few pregnant females have usual intakes >AI for potassium (2%) and choline (8%), whereas only 48% have vitamin K intakes >AI. The majority of pregnant women (95%) exceed the UL for sodium, while folic acid (34%), iron (28%), calcium (3%), and zinc (7%) were also of concern for intakes >UL. ConclusionsMany U.S. pregnant women (>10% < EAR or < 10% >AI) do not consume enough of key nutrients during pregnancy specifically vitamins A, C, D, E, K, B6, folate, and choline and minerals including potassium, calcium, magnesium, and zinc, while almost all are at risk of excessive consumption of sodium, and many at risk of excessive consumption of folic acid and iron. Improved dietary guidance to help pregnant women meet and not exceed dietary recommendations is warranted. Funding SourcesNestle Nutrition.

Nutritional Status of Older Adults Who Are Overweight or Obese Compared to Those with a Healthy Weight, NHANES 2011–2014 (P01-001-19)

ObjectivesThe purpose was to evaluate nutritional status, food security, and related health factors of older adults who were overweight or obese compared to those with a healthy weight. MethodsData from 2969 adults aged ≥60 years from NHANES 2011–2014 were analyzed. Participants were categorized by sex and body weight status as healthy weight (body mass index (BMI, kg/m2) 18.5–24.9), overweight (BMI 25–29.9), or obese (BMI ≥ 30); underweight individuals were excluded. Healthy Eating Index (HEI)-2015 scores and total usual micronutrient intakes from foods and dietary supplements were estimated using two 24-hour dietary recalls and the National Cancer Institute method. Nutritional biomarkers, including serum vitamin D, vitamin B-12, and methylmalonic acid, and cardiometabolic risk factors were also assessed. ResultsA substantial proportion of older adults (>30%) had intakes below Estimated Average Requirements (EAR) for calcium, magnesium, and vitamins C and D even with dietary supplements. Men and women with obesity had a higher prevalence of usual magnesium intakes <EAR compared to those with a healthy weight; among women only, the same was true for calcium, vitamins B-6 and D. Both men and women with obesity had significantly lower HEI-2015 scores than those with a healthy weight. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/L was higher in women with obesity (12%) than in women with a healthy weight (6%). Men and women who were overweight or obese were more likely to self-report fair/poor health, use ≥5 medications, and have cardiometabolic risk factors, including elevated blood pressure, triglycerides, and fasting blood glucose, and reduced high-density lipoprotein cholesterol, compared to individuals with a healthy weight. Women with obesity were more likely to be food-insecure and depressed, while men with obesity were less likely to consume government/community meals, compared to their counterparts. ConclusionsOlder adults with obesity had higher risk of inadequate intakes for several key micronutrients, lower overall dietary quality, and higher prevalence of cardiometabolic risk factors compared to older adults with a healthy weight. Funding SourcesThis work was supported by the National Institutes of Health.

Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring

The use of dietary supplements (DS) is pervasive and can provide substantial amounts of micronutrients to those who use them. Therefore when characterizing dietary intakes, describing the prevalence of inadequacy or excess, or assessing relations between nutrients and health outcomes, it is critical to incorporate DS intakes to improve exposure estimates. Unfortunately, little is known about the best methods to assess DS, and the structure of measurement error in DS reporting. Several characteristics of nutrients from DS are salient to understand when comparing to those in foods. First, DS can be consumed daily or episodically, in bolus form and can deliver discrete and often very high doses of nutrients that are not limited by energy intakes. These characteristics contribute to bimodal distributions and distributions severely skewed to the right. Labels on DS often provide nutrient forms that differ from those found in conventional foods, and underestimate analytically derived values. Finally, the bioavailability of many nutrient-containing DS is not known and it may not be the same as the nutrients in a food matrix. Current methods to estimate usual intakes are not designed specifically to handle DS. Two temporal procedures are described to refer to the order that nutrient intakes are combined relative to usual intake procedures, referred to as a "shrinking" the distribution to remove random error. The "shrink then add" approach is preferable to the "add then shrink" approach when users and nonusers are combined for most research questions. Stratifying by DS before usual intake methods is another defensible option. This review describes how to incorporate nutrient intakes from DS to usual intakes from foods, and describes the available methods and fit-for-purpose of different analytical strategies to address research questions where total usual intakes are of interest at the group level for use in nutrition research and to inform policy decisions. Clinical Trial Registry: NCT03400436.

Total Usual Nutrient Intakes of US Children (Under 48 Months): Findings from the Feeding Infants and Toddlers Study (FITS) 2016

BackgroundThe US Dietary Guidelines will expand in 2020 to include infants and toddlers. Understanding current dietary intakes is critical to inform policy.ObjectiveThe purpose of this analysis was to examine the usual total nutrient intakes from diet and supplements among US children.MethodsThe Feeding Infants and Toddlers Study 2016 is a national cross-sectional study of children aged <48 mo (n = 3235): younger infants (birth to 5.9 mo), older infants (6–11.9 mo), toddlers (12–23.9 mo), younger preschoolers (24–36.9 mo), and older preschoolers (36–47.9 mo) based on the use of a 24-h dietary recall. A second 24-h recall was collected from a representative subsample (n = 799). Energy, total nutrient intake distributions, and compliance with Dietary Reference Intakes were estimated with the use of the National Cancer Institute method.ResultsDietary supplement use was 15–23% among infants and toddlers and 35–45% among preschoolers. Dietary intakes of infants were adequate, with mean intakes exceeding Adequate Intake for all nutrients except vitamins D and E. Iron intakes fell below the Estimated Average Requirement for older infants (18%). We found that 31–33% of children aged 12–47.9 mo had low percentage of energy from total fat, and >60% of children aged 24–47.9 mo exceeded the saturated fat guidelines. The likelihood of nutrient inadequacy for many nutrients was higher for toddlers: 3.2% and 2.5% greater than the Adequate Intake for fiber and potassium and 76% and 52% less than the Estimated Average Requirement for vitamins D and E, respectively. These patterns continued through older ages. Intakes exceeded the Tolerable Upper Intake Level of sodium, retinol, and zinc across most age groups.ConclusionsDietary intakes of US infants are largely nutritionally adequate; concern exists over iron intakes in those aged 6–11.9 mo. For toddlers and preschoolers, high intake of sodium and low intakes of potassium, fiber, and vitamin D and, for preschoolers, excess saturated fat are of concern. Excess retinol, zinc, and folic acid was noted across most ages, especially among supplement users.

Adequacy of nutritional intake from food and supplements in a cohort of pregnant women in Québec, Canada: the 3D Cohort Study (Design, Develop, Discover)

Background: Assessments of the dietary intakes in various populations suggest that pregnant women have difficulty meeting all their nutritional requirements through diet alone. Few large-scale studies have considered both food sources and supplements in assessing the adequacy of nutritional intakes during pregnancy.Objective: Our study aimed to assess nutritional intakes during pregnancy by examining dietary sources and supplements. It then compared these findings with Dietary Reference Intakes.Design: We conducted a nutrition study in a large pregnancy cohort using a 3-d food record during the second trimester of pregnancy. Detailed information about supplement consumption was obtained by interview at each prenatal visit. We estimated the distribution of total usual intakes for energy, macronutrients, and micronutrients for 1533 pregnant women.Results: A third of the participants had total fat intakes that exceeded the Acceptable Micronutrient Distribution Range. A majority of women (85%) had sodium intakes above the Tolerable Upper Intake Level (UL). Median intakes for fiber and potassium were lower than Adequate Intakes. Dietary intakes of vitamin B-6, magnesium, and zinc were below the Estimated Average Requirements (EARs) for 10-15% of the women. A majority of the women had dietary intakes below the EARs for iron (97%), vitamin D (96%), and folate (70%). When we considered micronutrient intakes from both food and supplements, we found that the prevalence of inadequate intake was <10% for all nutrients except vitamin D (18%) and iron (15%), whereas 32% and 87% of the women had total intakes above the ULs for iron and folic acid, respectively.Conclusions: The level of intake of some nutrients from food alone remains low in the diets of pregnant women. Supplement use reduces the risk of inadequate intake for many micronutrients, but diet-related issues during pregnancy remain and deserve to be addressed in public health interventions. This trial was registered at clinicaltrials.gov as NCT03113331.

Total Usual Intake of Shortfall Nutrients Varies With Poverty Among US Adults

ObjectiveTo examine shortfall nutrient intakes (ie, calcium, folate, potassium, magnesium, and vitamins A, C, D, and E) by poverty-to-income ratio (PIR). DesignNational Health and Nutrition Examination Survey 2011–2012, a nationally representative, cross-sectional survey. ParticipantsUS adults with complete data on poverty status and diet were included (n = 4,524). AnalysisThe National Cancer Institute method was used to estimate total usual micronutrient intakes from foods, beverages, medications, and dietary supplements reported on 2 24-hour dietary recalls using measurement error correction. Main Outcome MeasuresCalcium, folate, potassium, magnesium, and vitamins A, C, D, and E across 3 PIR categories: <130%, 130% to 350%, and ≥350%. ResultsMean intakes of folate, vitamin C, and vitamin D were significantly greater in men, and magnesium in women, across all PIR categories. Except for calcium in men and vitamin C in women, the highest PIR category had significantly higher mean total usual intakes of all remaining shortfall micronutrients. Importantly, men and women in the highest PIR category (≥350%) were significantly less likely to have intakes below the Estimated Average Requirement across all micronutrients compared with those in the lower PIR categories. Conclusions and ImplicationsEven with dietary supplements, large proportions of US adults have micronutrient intakes below the Estimated Average Requirement. Adults at the highest adjusted income have higher micronutrient intakes and lower risk of inadequacy than those with lower incomes.

Total Usual Intake of Most Shortfall Nutrients Varies with Poverty among U.S. adults

Demographic trends indicate that the proportion of Americans living in poverty has been steadily increasing, and that those in poverty are more likely to be overweight or obese. Paradoxically, a combined over‐consumption of energy exists simultaneously with nutrient shortfalls. However, little is known about how poverty affects total micronutrient intakes, including dietary supplements. The objective of this study was to examine total usual shortfall micronutrient intakes (i.e., calcium, folate, potassium, magnesium, and vitamins A, C, D, E) by poverty‐to‐income ratio (PIR). Adults (≥19 y) who participated in NHANES 2011–2012, a nationally‐representative, cross‐sectional survey, and had complete data on poverty status and diet were included (n = 4,524); three PIR categories were constructed: &lt;130%, 130%–350%, and ≥350%. The National Cancer Institute method was used to estimate total usual micronutrient intakes from foods, beverages, medications, and dietary supplements reported on 2 24‐hour dietary recalls using measurement error correction. Dietary supplement use was significantly different in each PIR group: 38% (&lt;130%), 49% (130–350%), and 63% (≥350%); women had a higher prevalence of supplement use, and a higher percentage of micronutrients contributed from dietary supplements than men across all PIR categories. Within each PIR category, mean intakes of folate, vitamin C, vitamin D significantly increased in men and magnesium significantly increased in women. Except for calcium in men and vitamin C in women, the highest PIR category had significantly higher mean total usual intakes of all remaining shortfall micronutrients. Importantly, men and women in the highest PIR category (≥350%) were significantly less likely to have intakes below the Estimate Average Requirement (EAR) across all micronutrients compared with those in the lower PIR categories. Even with dietary supplements, large proportions of U.S. adults have micronutrient intakes below the EAR. Adults at the highest adjusted income have higher micronutrient intakes and lower risk of inadequacy than those than those with lower incomes.Support or Funding InformationThis work was supported through an unrestricted educational grant to Columbia University by Pharmavite, LLC.

Multivitamin/mineral supplement contribution to micronutrient intakes in the United States (806.15)

Multivitamin/mineral supplements are the most common dietary supplements consumed in the United States; however, intake data specific to how multivitamin/mineral supplements use contributes to micronutrient intakes among Americans are absent from the current scientific literature. This analysis aimed to assess contributions of micronutrients to usual intakes derived from multivitamin/mineral supplements and to compare those intakes to the Dietary Reference Intakes for U.S. residents aged 蠅4 y according to National Health and Nutrition Examination Survey, 2007‐2010 (n = 16,444). We used the National Cancer Institute method to assess usual intakes of 21 micronutrients. Our results showed that 51% of Americans consumed multivitamin/mineral supplements containing 蠅9 micronutrients. Large portions of the population had total usual intakes (food and multivitamin/mineral supplement use) below the estimated average requirement for vitamins A (35%), C (31%), D (74%), E (67%), calcium (39%), and magnesium (46%). Only 0, 8%, and 33% of the population had total usual intakes of potassium, choline, and vitamin K above the adequate intake when food and multivitamin/mineral use was considered. The percentage of the population with total intakes greater than the tolerable upper intake level was low for all nutrients; excess intakes of zinc were the highest (3.5%) across the population of all the nutrients assessed.Grant Funding Source: Council for Responsible Nutrition

Multivitamin/Mineral Supplement Contribution to Micronutrient Intakes in the United States, 2007–2010

Objective: Multivitamin/mineral (MVMM) supplements are the most common dietary supplements consumed in the United States; however, intake data specific to how MVMM use contributes to micronutrient intakes among Americans are absent from the current scientific literature. Methods: This analysis aimed to assess contributions of micronutrients to usual intakes derived from MVMM supplements and to compare those intakes to the dietary reference intakes for US residents aged ≥ 4 years according to the National Health and Nutrition Examination Survey (NHANES) 2007–2010 (n = 16,444). We used the National Cancer Institute method to assess usual intakes of 21 micronutrients. Results: Our results showed that 51% of Americans consumed MVMM supplements containing ≥ 9 micronutrients. Large portions of the population had total usual intakes (food and MVMM supplement use) below the estimated average requirement for vitamins A (35%), C (31%), D (74%), and E (67%) as well as calcium (39%) and magnesium (46%). Only 0%, 8%, and 33% of the population had total usual intakes of potassium, choline, and vitamin K above the adequate intake when food and MVMM use was considered. The percentage of the population with total intakes greater than the tolerable upper intake level (UL) was very low for all nutrients; excess intakes of zinc were the highest (3.5%) across the population of all of the nutrients assessed in NHANES. Conclusions: In large proportions of the population, micronutrient sufficiency is currently not being achieved through food solutions for several essential vitamins and minerals. Use of age- and gender-specific MVMM supplements may serve as a practical means to increase the micronutrient status in subpopulations of Americans while not increasing intakes above the UL.

Dietary intake of artificial sweeteners by the Belgian population

This study investigated whether the Belgian population older than 15 years is at risk of exceeding ADI levels for acesulfame-K, saccharin, cyclamate, aspartame and sucralose through an assessment of usual dietary intake of artificial sweeteners and specific consumption of table-top sweeteners. A conservative Tier 2 approach, for which an extensive label survey was performed, showed that mean usual intake was significantly lower than the respective ADIs for all sweeteners. Even consumers with high intakes were not exposed to excessive levels, as relative intakes at the 95th percentile (p95) were 31% for acesulfame-K, 13% for aspartame, 30% for cyclamate, 17% for saccharin, and 16% for sucralose of the respective ADIs. Assessment of intake using a Tier 3 approach was preceded by optimisation and validation of an analytical method based on liquid chromatography with mass spectrometric detection. Concentrations of sweeteners in various food matrices and table-top sweeteners were determined and mean positive concentration values were included in the Tier 3 approach, leading to relative intakes at p95 of 17% for acesulfame-K, 5% for aspartame, 25% for cyclamate, 11% for saccharin, and 7% for sucralose of the corresponding ADIs. The contribution of table-top sweeteners to the total usual intake (<1% of ADI) was negligible. A comparison of observed intake for the total population with intake for diabetics (acesulfame-K: 3.55 versus 3.75; aspartame: 6.77 versus 6.53; cyclamate: 1.97 versus 2.06; saccharine: 1.14 versus 0.97; sucralose: 3.08 versus 3.03, expressed as mg kg−1 bodyweight day−1 at p95) showed that the latter group was not exposed to higher levels. It was concluded that the Belgian population is not at risk of exceeding the established ADIs for sweeteners.

Foods, Fortificants, and Supplements: Where Do Americans Get Their Nutrients?

Limited data are available on the source of usual nutrient intakes in the United States. This analysis aimed to assess contributions of micronutrients to usual intakes derived from all sources (naturally occurring, fortified and enriched, and dietary supplements) and to compare usual intakes to the Dietary Reference Intake for U.S. residents aged ≥2 y according to NHANES 2003–2006 (n = 16,110). We used the National Cancer Institute method to assess usual intakes of 19 micronutrients by source. Only a small percentage of the population had total usual intakes (from dietary intakes and supplements) below the estimated average requirement (EAR) for the following: vitamin B-6 (8%), folate (8%), zinc (8%), thiamin, riboflavin, niacin, vitamin B-12, phosphorus, iron, copper, and selenium (<6% for all). However, more of the population had total usual intakes below the EAR for vitamins A, C, D, and E (34, 25, 70, and 60%, respectively), calcium (38%), and magnesium (45%). Only 3 and 35% had total usual intakes of potassium and vitamin K, respectively, greater than the adequate intake. Enrichment and/or fortification largely contributed to intakes of vitamins A, C, and D, thiamin, iron, and folate. Dietary supplements further reduced the percentage of the population consuming less than the EAR for all nutrients. The percentage of the population with total intakes greater than the tolerable upper intake level (UL) was very low for most nutrients, whereas 10.3 and 8.4% of the population had intakes greater than the UL for niacin and zinc, respectively. Without enrichment and/or fortification and supplementation, many Americans did not achieve the recommended micronutrient intake levels set forth in the Dietary Reference Intake.

Fluid intake and the risk of urothelial cell carcinomas in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Results from previous studies investigating the association between fluid intake and urothelial cell carcinomas (UCC) are inconsistent. We evaluated this association among 233,236 subjects in the European Prospective Investigation into Cancer and Nutrition (EPIC), who had adequate baseline information on water and total fluid intake. During a mean follow-up of 9.3 years, 513 first primary UCC occurred. At recruitment, habitual fluid intake was assessed by a food frequency questionnaire. Multivariable hazard ratios were estimated using Cox regression stratified by age, sex and center and adjusted for energy intake, smoking status, duration of smoking and lifetime intensity of smoking. When using the lowest tertile of intake as reference, total fluid intake was not associated with risk of all UCC (HR 1.12; 95%CI 0.86-1.45, p-trend = 0.42) or with risk of prognostically high-risk UCC (HR 1.28; 95%CI 0.85-1.93, p-trend = 0.27) or prognostically low-risk UCC (HR 0.93; 95%CI 0.65-1.33, p-trend = 0.74). No associations were observed between risk of UCC and intake of water, coffee, tea and herbal tea and milk and other dairy beverages. For prognostically low-risk UCC suggestions of an inverse association with alcoholic beverages and of a positive association with soft drinks were seen. Increased risks were found for all UCC and prognostically low-risk UCC with higher intake of fruit and vegetable juices. In conclusion, total usual fluid intake is not associated with UCC risk in EPIC. The relationships observed for some fluids may be due to chance, but further investigation of the role of all types of fluid is warranted.

Estimation of Total Usual Calcium and Vitamin D Intakes in the United States1–3

Our objective in this study was to estimate calcium intakes from food, water, dietary supplements, and antacids for U.S. citizens aged ≥1 y using NHANES 2003–2006 data and the Dietary Reference Intake panel age groupings. Similar estimates were calculated for vitamin D intake from food and dietary supplements using NHANES 2005–2006. Diet was assessed with 2 24-h recalls; dietary supplement and antacid use were determined by questionnaire. The National Cancer Institute method was used to estimate usual nutrient intake from dietary sources. The mean daily nutrient intake from supplemental sources was added to the adjusted dietary intake estimates to produce total usual nutrient intakes for calcium and vitamin D. A total of 53% of the U.S. population reported using any dietary supplement (2003–2006), 43% used calcium (2003–2006), and 37% used vitamin D (2005–2006). For users, dietary supplements provided the adequate intake (AI) recommendation for calcium intake for ∼12% of those ≥71 y. Males and females aged 1–3 y had the highest prevalence of meeting the AI from dietary and total calcium intakes. For total vitamin D intake, males and females ≥71, and females 14–18 y had the lowest prevalence of meeting the AI. Dietary supplement use is associated with higher prevalence of groups meeting the AI for calcium and vitamin D. Monitoring usual total nutrient intake is necessary to adequately characterize and evaluate the population’s nutritional status and adherence to recommendations for nutrient intake.

Predicted contribution of folic acid fortification of corn masa flour to the usual folic acid intake for the US population: National Health and Nutrition Examination Survey 2001–2004

BackgroundFolic acid can prevent up to 70% of neural tube defects (NTDs) if taken before pregnancy. Compared with other race-ethnicities, Hispanic women have higher rates of NTDs, lower rates of folic acid supplement use, and lower total folic acid intakes. ObjectiveThe objective was to assess potential effects of fortifying corn masa flour with folic acid on Mexican American women and other segments of the US population. DesignA model was developed by using data from the National Health and Nutrition Examination Survey 2001–2004 to estimate the folic acid content in foods containing corn masa flour if fortified at a level of 140 μg folic acid/100 g corn masa flour. ResultsHad corn masa flour fortification occurred, we estimated that Mexican American women aged 15–44 y could have increased their total usual daily folic acid intake by 19.9% and non-Hispanic white women by 4.2%. Among the US population, estimated relative percentage increases in total usual daily folic acid intake with corn masa flour fortification were greatest among Mexican Americans (16.8%) and lowest among children aged 1–3 y (2%) and adults aged >51 y (0–0.5%). ConclusionAnalyses suggest that corn masa flour fortification would have effectively targeted Mexican Americans, specifically, Mexican American women, without substantially increasing folic acid intake among other segments of the population. Such increases could reduce the disparity in total folic acid intake between Mexican American and non-Hispanic white women of childbearing age and implies that an additional NTD preventive benefit would be observed for Mexican American women.