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Coates PM, Bailey RL, Blumberg JB, El-Sohemy A, Floyd E, Goldenberg JZ, Gould Shunney A, Holscher HD, Nkrumah-Elie Y, Rai D, Ritz BW, Weber WJ. The Evolution of Science and Regulation of Dietary Supplements: Past, Present, and Future. J Nutr 2024; 154:2335-2345. [PMID: 38971530 DOI: 10.1016/j.tjnut.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/19/2024] [Accepted: 06/26/2024] [Indexed: 07/08/2024] Open
Abstract
Dietary supplement use in the United States is widespread and increasing, especially among certain population groups, such as older Americans. The science surrounding dietary supplements has evolved substantially over the last few decades since their formal regulation in 1994. Much has been learned about the mechanisms of action of many dietary supplement ingredients, but the evidence on their health effects is still building. As is true of much nutrition research, there are many studies that point to health effects, but not all are at the level of scientific evidence (e.g., randomized controlled interventions), rigor, or quality needed for definitive statements of efficacy regarding clinical end points. New technologies and approaches are being applied to the science of dietary supplements, including nutrigenomics and microbiome analysis, data science, artificial intelligence (AI), and machine learning-all of which can elevate the science behind dietary supplements. Products can contain an array of bioactive compounds derived from foods as well as from medicinal plants, which creates enormous challenges in data collection and management. Clinical applications, particularly those aimed at providing personalized nutrition options for patients, have become more sophisticated as dietary supplements are incorporated increasingly into clinical practice and self-care. The goals of this article are to provide historical context for the regulation and science of dietary supplements, identify research resources, and suggest some future directions for science in this field.
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Affiliation(s)
- Paul M Coates
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, United States.
| | - Regan L Bailey
- Institute for Advancing Health Through Agriculture, Texas A&M University System, College Station, TX, United States
| | - Jeffrey B Blumberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Floyd
- McIlhenny Botanical Research Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, United States
| | - Joshua Z Goldenberg
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, United States
| | | | - Hannah D Holscher
- Department of Food Science and Human Nutrition, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | | | - Deshanie Rai
- OmniActive Health Technologies, Morristown, NJ, United States
| | - Barry W Ritz
- Nestlé Health Science, Bridgewater, NJ, United States
| | - Wendy J Weber
- National Center for Complementary and Integrative Health, National Institutes of Health, Bethesda, MD, United States
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Fulgoni VL, Agler A, Ricciuto L, DiFrancesco L, Williams D, Hertzler SR. Impact of Simulated Caloric Reduction on Nutrient Adequacy Among U.S. Adults with Overweight or Obesity (National Health and Nutrition Examination Survey [NHANES] 2015-2018). J Nutr 2024:S0022-3166(24)00403-6. [PMID: 39025331 DOI: 10.1016/j.tjnut.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Current guidelines for the treatment of obesity recommend dietary restriction to create a caloric deficit, and caloric reductions of 16% to 68% have been achieved in adults with overweight or obesity engaging in intentional weight loss programs. OBJECTIVES This study models the impact of simulated caloric reduction on nutrient adequacy among U.S. adults ≥19 y with overweight or obesity using National Health and Nutrition Examination Survey data (2015-2018). METHODS Four levels of caloric reduction (20%, 30%, 40%, and 50%) were modeled by prorating daily calorie intake such that usual intakes of 14 nutrients were reduced proportional to caloric reduction. The percentages below the estimated average requirement (EAR) or above the adequate intake (AI) were estimated at each level of caloric reduction, with and without dietary supplement use. Differences across percentages of simulated caloric reductions were determined using nonoverlapping confidence intervals of the means (97.5th percentile confidence intervals were used to approximate P < 0.05). RESULTS There were significant differences (P < 0.05) in percentages below the EAR (above the AI) between sequential levels of simulated caloric reduction for most of the nutrients analyzed (protein, vitamins A, B-6, folate, and C, calcium, iron, magnesium, potassium, and zinc). For example, after a simulated 30% caloric reduction, 25%-40% of the population had intakes below the EAR for protein, vitamin B-6, and zinc, and 75%-91% of the population had intakes below the EAR for vitamin A, calcium, and magnesium (vs. 4%-18% and 45%-56%, respectively, without caloric reduction). With the inclusion of dietary supplements, percentages below the EAR for all nutrients (except protein) were lower than those for food alone. CONCLUSIONS Caloric reduction may exacerbate nutrient inadequacies among adults with overweight or obesity. Inclusion of nutrient-dense foods, fortified foods, specially formulated products, and/or dietary supplements should be considered for those on calorie-restricted diets for long-term weight loss.
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Affiliation(s)
| | - Anne Agler
- Abbott Nutrition, Columbus, OH, United States
| | - Laurie Ricciuto
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
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Twum F, Cowan L, Yu L, Afriyie-Gyawu E, Zhang J. High red blood cell folate is associated with an increased risk of diabetes death among a hypertensive cohort. Nutr Res 2024; 126:204-214. [PMID: 38763110 DOI: 10.1016/j.nutres.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
The relationship between folate and diabetes remains inconclusive, possibly because of folate measured differentially between studies. Interference from mandatory folic acid fortification (FAF) has also been blamed. With both folate intake and circulating concentration measured, we assessed the relationship between folate and the risk of diabetes death in a hypertensive cohort established before FAF. We hypothesized that the association between folate and diabetes death is measurement dependent. We analyzed the data of 3133 hypertensive adults aged ≥19 years who participated in the Third National Health and Nutrition Examination Survey (1991-1994) and were followed up through December 31, 2010. Hazard ratios of diabetes death were estimated for participants with high (4th quarter) folate compared with those with moderate (2nd and 3rd quarters) or low (1st quarter) concentrations of folate. Dietary folate intake, total folate intake (including folate from supplements), serum, and red blood cell (RBC) folate were measured. After 42,025 person-years of follow-up, 165 diabetes deaths were recorded, and a dose-response positive association was observed between diabetes death and RBC folate. The adjusted hazard ratios of diabetes death were 1.00 (reference), 1.42 (95% CI. 1.20-1.68), and 2.21 (1.73-2.82), respectively, for hypertensive adults with low, moderate, and high RBC folate. No association was detected between diabetes death and serum folate concentration, folate intake, or either dietary intake or total intake. With minimized interference from FAF, neither dietary nor serum folate was associated with diabetes death, but elevated RBC folate was associated with a high risk of diabetes deaths among hypertensive patients.
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Affiliation(s)
- Felix Twum
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA; School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, USA.
| | - Logan Cowan
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Lili Yu
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Evans Afriyie-Gyawu
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
| | - Jian Zhang
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
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Gibson R, Aljuraiban GS, Oude Griep LM, Vu TH, Steffen LM, Appel LJ, Rodriguez BL, Daviglus ML, Elliott P, Van Horn L, Chan Q. Relationship of calcium and magnesium intakes with the dietary approaches to stop hypertension score and blood pressure: the International Study of Macro/micronutrients and Blood Pressure. J Hypertens 2024; 42:789-800. [PMID: 38164982 PMCID: PMC10990009 DOI: 10.1097/hjh.0000000000003648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Research investigating calcium and magnesium intakes from the Dietary Approaches to Stop Hypertension (DASH) pattern and other sources in association with blood pressure is limited. We aimed to characterize sources/intake levels of calcium and magnesium in relation to overall diet quality (DASH-score) and determine modification effects with DASH score and blood pressure. METHODS Cross-sectional United States data (average dietary and supplement intake from four 24 h recalls and eight blood pressure measurements) from two separate visits, 2195 men and women (40-59 years) in the International Study of Macro/Micronutrients and Blood Pressure were analysed. Food-based adherence to the DASH diet was estimated. Linear models tested associations between each 1-point DASH score with blood pressure. Participants were stratified by adherence to sex-specific recommended allowance for magnesium and calcium intakes. Effect-modification was tested across DASH-score quintiles and median of urinary sodium. RESULTS DASH-score was inversely associated with SBP in fully adjusted models (-0.27; 95%CI: -0.38 to -0.15 mmHg). SBP was inversely associated with dietary calcium intake from DASH food groups: -1.54 (95% CI: -2.65 to -0.43) mmHg; calcium intake from other non-DASH food groups: -1.62 (95% CI: -2.94 to -0.29) mmHg. Dietary magnesium intake from DASH food groups (-1.59; 95% CI: -2.79, -0.40 mmHg) and from other non-DASH foods (-1.92; 95% CI: -3.31, -0.53 mmHg) was inversely associated with SBP. CONCLUSION A higher DASH score showed a consistent association with lower BP suggesting a relationship between intakes of calcium and Mg with BP regardless of whether the source is part of the DASH diet or not, even when adjusted for supplement intakes.The INTERMAP is registered as NCT00005271 at www.clinicaltrials.gov .
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Affiliation(s)
- Rachel Gibson
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
- Department of Nutritional Sciences, King's College London, United Kingdom
| | - Ghadeer S. Aljuraiban
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Linda M. Oude Griep
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
- NIHR Biomedical Research Centre, Diet, Anthropometry, and Physical Activity (DAPA), MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Thanh-Huyen Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Lawrence J. Appel
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Beatriz L. Rodriguez
- Department of Geriatric Medicine, University of Hawaii at Manoa, Honolulu, Hawaii
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London
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5
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Freedman MR, Fulgoni VL, Lieberman HR. Temporal changes in micronutrient intake among United States Adults, NHANES 2003 through 2018: A cross-sectional study. Am J Clin Nutr 2024; 119:1309-1320. [PMID: 38373695 DOI: 10.1016/j.ajcnut.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Changes in the United States food supply and food choices make examination of temporal changes in micronutrient intake and their effect on meeting nutrient recommendations necessary. OBJECTIVES This study aimed to examine 15-year trends of the contribution of foods and beverages (FB) and dietary supplements (DSs) to meeting nutrient recommendations among United States adults aged 19 y or older and compare usual mean intake distributions of FB alone with those of FB+DSs with dietary reference intakes [percentage below the estimated average requirement (%AI)]. METHODS This cross-sectional study used food, beverage, and DSs intake data from NHANES 2003-2018 (N = 39,925) to determine usual mean intakes for 21 micronutrients. Changes in intakes from FB and from FB+DSs, by sex, were compared in a time-trend analysis of 2-y cycles. Changes in mean intake as %AI were determined. RESULTS Over the time studied, United States adults underconsumed vitamins A, C, D, E, and K; calcium; potassium; magnesium; and choline, even when DSs intake was included. Sodium was overconsumed. In males, there were significant increases in % CONCLUSIONS Although some progress has been made, nutrient intake and percentage of the population meeting nutritional recommendations among United States adults has changed little over the 15 y studied.
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Affiliation(s)
- Marjorie R Freedman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, United States; Oak Ridge Institute for Science and Education, Belcamp, MD, United States.
| | - Victor L Fulgoni
- Nutrition Impact, 9725 D Drive North, Battle Creek, MI, United States
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, United States
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Arlauskas R, Austys D, Dobrovolskij V, Stukas R. Consumption of Dietary Supplements among Working-Age Residents of Lithuania in the Period from 2021 to 2023. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:669. [PMID: 38674315 PMCID: PMC11051780 DOI: 10.3390/medicina60040669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: The aim of this study was to assess the consumption of dietary supplements (DS) among working-age residents of Lithuania from 2021 to 2023 with respect to social and demographic factors and an assessment of personal health. Materials and Methods: Using stratified sampling techniques, this study included three samples of working-age residents (1600 each year, 4800 total). Three surveys were conducted, the distribution of the respondents between groups was compared using the χ2 test. Results: The consumption of DS significantly differed each year and accounted for 78.1%, 71.6%, and 72.7% of the respondents, respectively (p < 0.05). In 2022, the prevalence of the consumption of DS was lower in the majority of social and demographic groups (p < 0.05). In 2023, it was higher among females, younger residents, and those from larger families, who suffered from COVID-19 (p < 0.05). Despite similar changes found in the consumption of DS among those who negatively assessed their health, this group showed more prevalent consumption of DS among residents with non-university education, unemployed respondents, and those with lower income (p < 0.05). Conclusions: Despite a significantly lower prevalence in the consumption of DS in 2022, it was higher again in 2023. The assessment of personal health shows different habits in the consumption of DS.
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Affiliation(s)
- Rokas Arlauskas
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, M. K. Čiurlionio 21/27, 03101 Vilnius, Lithuania; (D.A.); (V.D.); (R.S.)
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7
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Papatesta EM, Kanellou A, Peppa E, Trichopoulou A. Is Dietary (Food) Supplement Intake Reported in European National Nutrition Surveys? Nutrients 2023; 15:5090. [PMID: 38140349 PMCID: PMC10871081 DOI: 10.3390/nu15245090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Dietary (food) supplements (DSs) have seen a sharp increase in use and popularity in recent years. Information on DS consumption is vital for national nutrition monitoring. The objective of this study was to investigate whether DS intake was reported in the National Nutrition Surveys (NNSs) in all European countries. NNSs reporting DS use were retrieved via literature review (i.e., PubMed, Google Scholar, Scopus), scientific and organizational publications (EFSA), or open-published government and other official reports. Included were the European NNSs referring to adults, published in English, French, or German, post-2000. Out of the 53 European countries, 30 recorded DS intake. Among them, related findings on the percentage of DS intake were published in 21 cases, 5 of them written in the local language. DS use varied by nation, with Finland and Denmark having the greatest (over 50%) and Italy having the lowest percentage (5%). In terms of comprehensive reported data on DS consumption in Europe and the investigation of the contribution of DSs to total nutrient intake, there is a need for improvement. Common DS categories should be defined upon agreement among the involved scientific parties to allow for comparable data and estimations between surveys.
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Affiliation(s)
- Eleni Maria Papatesta
- Center for Public Health Research and Education, Academy of Athens, Alexandroupoleos 23, 11528 Athens, Greece; (E.M.P.); (A.K.); (E.P.)
| | - Anastasia Kanellou
- Center for Public Health Research and Education, Academy of Athens, Alexandroupoleos 23, 11528 Athens, Greece; (E.M.P.); (A.K.); (E.P.)
- Department of Food Science and Technology, University of West Attica (UniWA), 28 Agiou Spyridonos Str., 12243 Egaleo-Athens, Greece
| | - Eleni Peppa
- Center for Public Health Research and Education, Academy of Athens, Alexandroupoleos 23, 11528 Athens, Greece; (E.M.P.); (A.K.); (E.P.)
| | - Antonia Trichopoulou
- Center for Public Health Research and Education, Academy of Athens, Alexandroupoleos 23, 11528 Athens, Greece; (E.M.P.); (A.K.); (E.P.)
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece
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Devarshi PP, Gustafson K, Grant RW, Mitmesser SH. Higher intake of certain nutrients among older adults is associated with better cognitive function: an analysis of NHANES 2011-2014. BMC Nutr 2023; 9:142. [PMID: 38053133 PMCID: PMC10696734 DOI: 10.1186/s40795-023-00802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/24/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND An increasing number of adults are over the age of 65, and there is concern about the increasing prevalence of age-associated cognitive decline and poor mental health status in older adults in the United States. Several nutrients are known to have important biological roles in brain health and neurological function, but many individuals fall short of recommended intake levels. The objective of this study was to examine the association between nutrient intake and cognitive function. We also explored whether nutrient intake was associated with depression. METHODS This cross-sectional study was based on data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 and included participants ≥ 60 years of age who had reliable day 1 dietary recall data and either valid cognitive function data (n = 2713) or valid depression score data (n = 2943). The sample was stratified by gender, and cognitive functioning test (CFT) composite z-scores were analyzed by quartiles. Depression status was assessed using the Patient Health Questionnaire (PHQ-9). RESULTS Higher intake and adequacy of a number of different nutrients from food were associated with higher cognitive function in both males and females. Nutrients that showed the most consistent associations with cognitive function across intake and adequacy analyses for food in both males and females were vitamin A, vitamin E, thiamin, riboflavin, vitamin B6, folate, magnesium, potassium, zinc, vitamin K, and lutein and zeaxanthin (p < 0.05 for all). These associations were positive with increasing intake and adequacy being associated with higher CFT composite z-scores. Analysis of nutrient intake and depression yielded results that differed by gender. In females, the nutrients that showed consistent inverse associations with depression scores across both intake and adequacy analyses for food were vitamin A, vitamin C, magnesium, vitamin K, potassium, and dietary fiber (p < 0.05 for all). In males, no significant associations between nutrient intake from food and depression scores were observed. CONCLUSIONS Our findings suggest that older adults with sufficient intakes of certain essential nutrients have higher cognitive function. Future studies are needed to confirm whether a well-balanced diet and/or dietary supplements which emphasize these nutrients are effective for prevention of age-related declines in cognitive function and mood.
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Affiliation(s)
- Prasad P Devarshi
- Science and Technology, Pharmavite, LLC, 8531 Fallbrook Ave, West Hills, CA, 91304, USA
| | - Kelsey Gustafson
- Science and Technology, Pharmavite, LLC, 8531 Fallbrook Ave, West Hills, CA, 91304, USA.
| | - Ryan W Grant
- Science and Technology, Pharmavite, LLC, 8531 Fallbrook Ave, West Hills, CA, 91304, USA
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Eveleigh E, Coneyworth L, Craigon J, Welham S. Adoption of a Short-Term (4-Week) Vegan Diet as Part of 'Veganuary' Significantly Reduces Saturated Fatty Acid (SFA), Cholesterol, B12, and Iodine Intake in Omnivorous Individuals-An Observational Study. Nutrients 2023; 15:4967. [PMID: 38068825 PMCID: PMC10708059 DOI: 10.3390/nu15234967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Global veganism campaigns like 'Veganuary' have gained popularity. We conducted an observational study to assess the impact of a 4-week vegan diet during 'Veganuary' on nutrient intake, status, knowledge, and motivations for veganism. Data were collected before and after 'Veganuary', using Food Frequency Questionnaires (FFQs) to estimate dietary intake. Micronutrient knowledge and motivation were assessed through questionnaires. A total of 154 UK adults aged 18-60 years (2019: n81; 2020: n73) participated. Groups were vegetarians and omnivores committed to a 4-week vegan diet during 'Veganuary'. Control groups were vegans and omnivores who did not transition. Short-term vegan diets significantly decreased intake of iodine, B12, cholesterol, and saturated fatty acids (SFAs) in omnivores. Micronutrient knowledge was low, and motivation for veganism varied. Short-term vegan diets reduce macro- and micronutrient intake in omnivores. Veganuary participants could benefit from nutritional guidance or supplementation. Attention is required for UK micronutrient intake and knowledge. Motivations for vegan pledges may influence diets, warranting further research.
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Affiliation(s)
- Elizabeth Eveleigh
- Division of Food, Nutrition and Dietetics, School of Biosciences, The University of Nottingham, Sutton Bonington LE12 5RD, UK; (E.E.); (L.C.)
| | - Lisa Coneyworth
- Division of Food, Nutrition and Dietetics, School of Biosciences, The University of Nottingham, Sutton Bonington LE12 5RD, UK; (E.E.); (L.C.)
| | - Jim Craigon
- School of Biosciences, The University of Nottingham, Sutton Bonington LE12 5RD, UK;
| | - Simon Welham
- Division of Food, Nutrition and Dietetics, School of Biosciences, The University of Nottingham, Sutton Bonington LE12 5RD, UK; (E.E.); (L.C.)
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10
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Gaml-Sørensen A, Brix N, Lunddorf LLH, Ernst A, Høyer BB, Toft G, Henriksen TB, Ramlau-Hansen CH. Maternal Intake of Vitamin D Supplements during Pregnancy and Pubertal Timing in Children: A Population-Based Follow-Up Study. Nutrients 2023; 15:4039. [PMID: 37764822 PMCID: PMC10536415 DOI: 10.3390/nu15184039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Maternal vitamin D may be important for several organ systems in the offspring, including the reproductive system. In this population-based follow-up study of 12,991 Danish boys and girls born 2000-2003, we investigated if maternal intake of vitamin D supplements during pregnancy was associated with pubertal timing in boys and girls. Information on maternal intake of vitamin D supplements was obtained by self-report in mid-pregnancy. Self-reported information on the current status of various pubertal milestones was obtained every six months throughout puberty. Mean differences in months at attaining each pubertal milestone and an average estimate for the mean difference in attaining all pubertal milestones were estimated according to maternal intake of vitamin D supplements using multivariable interval-censored regression models. Lower maternal intake of vitamin D supplements was associated with later pubertal timing in boys. For the average estimate, boys had 0.5 months (95% CI 0.1; 0.9) later pubertal timing per 5 µg/day lower maternal vitamin D supplement intake. Maternal intake of vitamin D supplements was not associated with pubertal timing in girls. Spline plots and sensitivity analyses supported the findings. Whether the observed association with boys' pubertal timing translates into an increased risk of disease in adulthood is unknown.
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Affiliation(s)
- Anne Gaml-Sørensen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
| | - Nis Brix
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Lea Lykke Harrits Lunddorf
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
| | - Andreas Ernst
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
- Department of Urology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Birgit Bjerre Høyer
- Open Patient Data Explorative Network, Odense University Hospital, 5000 Odense, Denmark
| | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Tine Brink Henriksen
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Cecilia Høst Ramlau-Hansen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Bartholins Alle 2, 8000 Aarhus C, Denmark
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Bailey RL, Jun S, Cowan AE, Eicher-Miller HA, Gahche JJ, Dwyer JT, Hartman TJ, Mitchell DC, Seguin-Fowler RA, Carroll RJ, Tooze JA. Major Gaps in Understanding Dietary Supplement Use in Health and Disease. Annu Rev Nutr 2023; 43:179-197. [PMID: 37196365 PMCID: PMC11078263 DOI: 10.1146/annurev-nutr-011923-020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Precise dietary assessment is critical for accurate exposure classification in nutritional research, typically aimed at understanding how diet relates to health. Dietary supplement (DS) use is widespread and represents a considerable source of nutrients. However, few studies have compared the best methods to measure DSs. Our literature review on the relative validity and reproducibility of DS instruments in the United States [e.g., product inventories, questionnaires, and 24-h dietary recalls (24HR)] identified five studies that examined validity (n = 5) and/or reproducibility (n = 4). No gold standard reference method exists for validating DS use; thus, each study's investigators chose the reference instrument used to measure validity. Self-administered questionnaires agreed well with 24HR and inventory methods when comparing the prevalence of commonly used DSs. The inventory method captured nutrient amounts more accurately than the other methods. Reproducibility (over 3 months to 2.4 years) of prevalence of use estimates on the questionnaires was acceptable for common DSs. Given the limited body of research on measurement error in DS assessment, only tentative conclusions on these DS instruments can be drawn at present. Further research is critical to advancing knowledge in DS assessment for research and monitoring purposes.
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Affiliation(s)
- Regan L Bailey
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | - Shinyoung Jun
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang-si, Republic of Korea
| | - Alexandra E Cowan
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | | | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland, USA
| | - Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, Maryland, USA
- Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Terryl J Hartman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Diane C Mitchell
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | - Rebecca A Seguin-Fowler
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, Texas, USA;
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, Texas, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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12
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Qin Y, Cowan AE, Bailey RL, Jun S, Eicher-Miller HA. Usual nutrient intakes and diet quality among United States older adults participating in the Supplemental Nutrition Assistance Program compared with income-eligible nonparticipants. Am J Clin Nutr 2023; 118:85-95. [PMID: 37407169 PMCID: PMC10493427 DOI: 10.1016/j.ajcnut.2023.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/07/2023] [Accepted: 03/09/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND The proportion of older adults with food insecurity at 8% has increased faster than that of the general United States population from 2001 to 2017. Many low-income food-insecure older adults rely on food-assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), for meeting energy and nutrient needs, whereas others are eligible but do not participate. Neither updated nutrient intake estimates nor potential differences in meeting the Dietary Reference Intakes from foods alone and with dietary supplements (DS) among low-income older adults using or eligible for SNAP are known. OBJECTIVES This study assessed and compared national estimates of usual nutrient adequacy and dietary quality of United States older adults using SNAP and income-eligible nonparticipants. METHODS Usual dietary intake was estimated among older adults (≥60 y; n = 2582) in the 2007-2016 NHANES cross-sectional national survey. Data on food-assistance participation and eligibility (poverty-income-ratio ≤130%), DS use, and ≥24-h dietary recalls were used. The NCI method (Markov Chain Monte Carlo approach) was applied to estimate mean usual nutrient intakes, proportion of inadequate nutrient intake, and dietary quality using the 2015 Healthy Eating Index. RESULTS Neither usual nutrient intake from dietary and total sources nor dietary quality differed between older adult SNAP participants and eligible nonparticipants. Low dietary quality and high percentage of inadequate intake for several nutrients were apparent among both groups, especially from food sources alone, including vitamins A (56%), C (55%), D (97%), E (99%), calcium (73%), and magnesium (74%), but rates were attenuated when DS were also considered (i.e., 36% reduced risk for vitamin D inadequacy). CONCLUSIONS Diet quality and usual nutrient intake among older adult SNAP participants and eligible nonparticipants were poor, but DS lowered the risk of nutrient inadequacy. Future policies and programs should focus on improving the intake of vitamins A, C, D, E, calcium, and magnesium and dietary quality for all older adults.
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Affiliation(s)
- Yue Qin
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| | - Alexandra E Cowan
- Institute for Advancing Health through Agriculture, Texas A&M University, College Station, TX, United States
| | - Regan L Bailey
- Institute for Advancing Health through Agriculture, Texas A&M University, College Station, TX, United States
| | - Shinyoung Jun
- Department of Cancer Biomedical Science, National Cancer Center Graduate School of Cancer Science and Policy, Goyang-si, Republic of Korea
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13
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Zhou Y, Wang A, Yeung LF, Qi YP, Pfeiffer CM, Crider KS. Folate and vitamin B12 usual intake and biomarker status by intake source in United States adults aged ≥19 y: NHANES 2007-2018. Am J Clin Nutr 2023; 118:241-254. [PMID: 37172826 PMCID: PMC10926004 DOI: 10.1016/j.ajcnut.2023.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Folate and vitamin B12 are important biomarkers of nutritional status of populations. OBJECTIVES This study aims to estimate folate and vitamin B12 usual intakes among United States adults and examine folate and vitamin B12 biomarker status by intake source. METHODS We analyzed data for United States adults aged ≥19 y from National Health and Nutrition Examination Survey 2007-2018 (n = 31,128), during which time voluntary corn masa flour (CMF) fortification was started. Usual intake was estimated using the National Cancer Institute method. Folate intake included folate from natural foods and folic acid from 4 sources: enriched cereal grain products (ECGPs), CMF, ready-to-eat cereals (RTEs), and folic acid-containing supplements (SUP). Vitamin B12 intake was mainly from food and supplements. RESULTS The median natural food folate intake (222 μg dietary folate equivalents (DFE)/d) was below the estimated average requirement (EAR) of 320 μg DFE/d. The proportions of those who consumed folic acid from ECGP/CMF only, ECGP/CMF + RTE, ECGP/CMF + SUP, and ECGP/CMF + RTE + SUP were 50%, 18%, 22%, and 10%, respectively. Median usual folic acid intakes (μg/d) were 236 (IQR: 152, 439) overall and 134, 313, 496, and 695 in the ECGP/CMF only, ECGP/CMF + RTE, ECGP/CMF + SUP, and ECGP/CMF + RTE + SUP folic acid consumption groups, respectively. Overall, 2.0% (95% CI: 1.7%, 2.3%) of adults, all of whom used folic acid supplements, consumed greater than the tolerable upper intake level (UL) of 1000 μg/d folic acid. The median usual vitamin B12 intake (μg/d) was 5.2 for vitamin B12 supplement nonusers and 21.8 for users. Consumption of RTE and/or supplements with folic acid was associated with higher serum and red blood cell folate concentrations. Vitamin B12 supplement users had significantly higher serum vitamin B12 concentrations. CONCLUSIONS Folic acid fortification plays a critical role in helping United States adults meet the folate EAR. At current fortification levels, United States adults who do not consume supplements do not have the usual folic acid intake exceeding the UL.
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Affiliation(s)
- Ying Zhou
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Arick Wang
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lorraine F Yeung
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine M Pfeiffer
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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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. Nutrients 2023; 15:nu15010234. [PMID: 36615891 PMCID: PMC9824044 DOI: 10.3390/nu15010234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
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.
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Vosti SA, Adams KP, Michuda A, Ortiz-Becerra K, Luo H, Haile D, Chou VB, Clermont A, Teta I, Ndjebayi A, Kagin J, Guintang J, Engle-Stone R. Impacts of micronutrient intervention programs on effective coverage and lives saved: Modeled evidence from Cameroon. Ann N Y Acad Sci 2023; 1519:199-210. [PMID: 36471541 DOI: 10.1111/nyas.14937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Policymakers are committed to improving nutritional status and to saving lives. Some micronutrient intervention programs (MIPs) can do both, but not to the same degrees. We apply the Micronutrient Intervention Modeling tool to compare sets of MIPs for (1) achieving dietary adequacy separately for zinc, vitamin A (VA), and folate for children and women of reproductive age (WRA), and (2) saving children's lives via combinations of MIPs. We used 24-h dietary recall data from Cameroon to estimate usual intake distributions of zinc and VA for children 6-59 months and of folate for WRA. We simulated the effects on dietary inadequacy and lives saved of four fortified foods and two VA supplementation (VAS) platforms. We estimated program costs over 10 years. To promote micronutrient-specific dietary adequacy, the economic optimization model (EOM) selected zinc- and folic acid-fortified wheat flour, VA-fortified edible oils, and bouillon cubes, and VAS via Child Health Days in the North macroregion. A different set of cost-effective MIPs emerged for reducing child mortality, shifting away from VA and toward more zinc for children and more folic acid for WRA. The EOM identified more efficient sets of MIPs than the business-as-usual MIPs, especially among programs aiming to save lives.
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Affiliation(s)
- Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California Davis, Davis, California, USA
| | - Katherine P Adams
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | - Aleksandr Michuda
- Center for Data Science for Enterprise and Society, Cornell University, Ithaca, New York, USA
| | - Karen Ortiz-Becerra
- Department of Agricultural and Resource Economics, University of California Davis, Davis, California, USA
| | - Hanqi Luo
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Demewoz Haile
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA.,Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Victoria B Chou
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adrienne Clermont
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ismael Teta
- Helen Keller International, Yaoundé, Cameroon
| | | | | | | | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
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16
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Wiedeman AM, Dhillon AK, Wu BT, Innis SM, Elango R, Devlin AM. Children Aged 5-6 Years in Vancouver, Canada Meet Dietary Recommendations for Folate and Vitamin B12 but not Choline. J Nutr 2023; 153:197-207. [PMID: 36913454 DOI: 10.1016/j.tjnut.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/17/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Choline, folate, and vitamin B12 are required for growth and development, but there is limited information on the intakes and relationships to biomarkers of status in children. OBJECTIVES The objective of this study was to determine the choline and B-vitamin intakes and relationship to biomarkers of status in children. METHODS A cross-sectional study was conducted in children (n = 285, aged 5-6 y) recruited from Metro Vancouver, Canada. Dietary information was collected by using 3 24-h recalls. Nutrient intakes were estimated by using the Canadian Nutrient File and United States Department of Agriculture database for choline. Supplement information was collected by using questionnaires. Plasma biomarkers were quantified by using mass spectrometry and commercial immunoassays, and relationships to dietary and supplement intake were determined by using linear models. RESULTS Daily dietary intakes of choline, folate, and vitamin B12 were [mean (SD)] 249 (94.3) mg, 330 (120) DFE μg, and 3.60 (1.54) μg, respectively. Top food sources of choline and vitamin B12 were dairy, meats, and eggs (63%-84%) and for folate, were grains, fruits, and vegetables (67%). More than half of the children (60%) were consuming a supplement containing B-vitamins, but not choline. Only 40% of children met the choline adequate intake (AI) recommendation for North America (≥250 mg/d); 82% met the European AI (≥170 mg/d). Less than 3% of children had inadequate folate and vitamin B12 total intakes. Some children (5%) had total folic acid intakes above the North American tolerable upper intake level (UL; >400 μg/d); 10% had intakes above the European UL (>300 μg/d). Dietary choline intake was positively associated with plasma dimethylglycine, and total vitamin B12 intake was positively associated with plasma B12 (adjusted models; P < 0.001). CONCLUSIONS These findings suggest that many children are not meeting the dietary choline recommendations, and some children may have excessive folic acid intakes. The impact of imbalanced one-carbon nutrient intakes during this active period of growth and development requires further investigation.
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Affiliation(s)
- Alejandra M Wiedeman
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Amneet K Dhillon
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Brian T Wu
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Sheila M Innis
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Rajavel Elango
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, Canada
| | - Angela M Devlin
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, Canada.
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17
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Higgins KA, Bi X, Davis BJK, Barraj LM, Scrafford CG, Murphy MM. Adequacy of total usual micronutrient intakes among pregnant women in the United States by level of dairy consumption, NHANES 2003-2016. Nutr Health 2022; 28:621-631. [PMID: 35132897 PMCID: PMC9716399 DOI: 10.1177/02601060211072325] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Kelly A Higgins
- Exponent,
Inc., Center for Chemical Regulation
& Food Safety, 1150 Connecticut Avenue, NW, Suite 1100, Washington, DC
20036
| | | | | | | | | | - Mary M Murphy
- Exponent, Inc., Center for Chemical
Regulation & Food Safety, 1150 Connecticut Avenue, NW, Suite 1100,
Washington, DC 20036.
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18
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Kanellou A, Papatesta EM, Martimianaki G, Peppa E, Stratou M, Trichopoulou A. Dietary supplement use in Greece: methodology and findings from the National Health and Nutrition Survey - HYDRIA (2013-2014). Br J Nutr 2022; 129:1-8. [PMID: 36210533 DOI: 10.1017/s000711452200321x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of dietary supplements (DS) is increasing worldwide. There is limited evidence of their intake level and mode of consumption in association with the Greek population's dietary and lifestyle habits. Adults (n 4011, 1873 males and 2138 females) aged > 18 years old living in Greece were included in the 2013-2014 National Health and Nutrition Survey - HYDRIA. A dietary supplement user (DSU) was defined as anyone who reported one or more DS on either a Food Propensity Questionnaire, two 24-h dietary recalls, or a questionnaire completed during the blood sample collection examination. DS use was examined according to socio-economic, anthropometric and lifestyle characteristics and the participants' health and dietary status. DS use was reported by 31 % of the population (40 % women and 22 % men), and it was higher among individuals living in urban areas, men with good self-reported health status and women with a chronic medical condition and higher consumption of fruits. The types of DS more frequently reported were multivitamins with minerals (5·4 %), Ca (5·3 %), multivitamins (4·7 %) and Fe (4·6 %). MVM supplements were preferred by men, while Ca was more frequently reported by women and participants with low education levels. Plant- and oil-based supplement use was below 5 %. Whether DS intake benefits health must be explored. It should also be assessed if dietary supplement intake is as efficient as food intake.
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Affiliation(s)
- Anastasia Kanellou
- Hellenic Health Foundation (HHF), 13 Kaisareias str. & 23 Alexandroupoleos str., Athens11527, Greece
- University of West Attica (UniWA), Department of Food Science and Technology, 28 Agiou Spyridonos str., Egaleo-Athens12243, Greece
| | - Eleni Maria Papatesta
- Hellenic Health Foundation (HHF), 13 Kaisareias str. & 23 Alexandroupoleos str., Athens11527, Greece
| | - Georgia Martimianaki
- Hellenic Health Foundation (HHF), 13 Kaisareias str. & 23 Alexandroupoleos str., Athens11527, Greece
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology 'G.A. Maccacaro', University of Milan, Via Giovanni Celoria 20, Milan, 20133, Italy
| | - Eleni Peppa
- Hellenic Health Foundation (HHF), 13 Kaisareias str. & 23 Alexandroupoleos str., Athens11527, Greece
| | - Maria Stratou
- Hellenic Health Foundation (HHF), 13 Kaisareias str. & 23 Alexandroupoleos str., Athens11527, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation (HHF), 13 Kaisareias str. & 23 Alexandroupoleos str., Athens11527, Greece
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Murphy R, Marshall K, Zagorin S, Devarshi PP, Hazels Mitmesser S. Socioeconomic Inequalities Impact the Ability of Pregnant Women and Women of Childbearing Age to Consume Nutrients Needed for Neurodevelopment: An Analysis of NHANES 2007-2018. Nutrients 2022; 14:nu14183823. [PMID: 36145198 PMCID: PMC9500720 DOI: 10.3390/nu14183823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Adequate consumption of nutrients that support infant neurodevelopment is critical among pregnant women and women of childbearing age. Understanding the potential effects of socioeconomic inequalities on nutrient gaps in these life stages is thus important for informing strategies to mitigate negative health consequences. Usual intake (foods and dietary supplements) of neurodevelopment-related nutrients was determined from 24 h recalls among women of childbearing age and pregnant women (20−44 years) using data from 2007−2018 NHANES. Usual intake was compared across household food security, poverty-to-income ratio (PIR), and household participation in federal food and nutrition assistance programs. Intake of EPA + DHA was universally low with >95% of all women (pregnant and non-pregnant) below the DGA recommendation from foods alone. Women in households that participated in the Supplemental Nutrition Assistance Program had a significantly lower intake of multiple nutrients relative to those who did not participate. For example, 50% had intakes below the estimated average requirement (EAR) for vitamin A (versus 32%), 42% were below the EAR for calcium (versus 33%) and 65% were below the EAR for magnesium (versus 42%). Similar gradients were observed by PIR and household food security, and among pregnant women whereby gaps were more evident in those experiencing socioeconomic inequalities. The use of dietary supplements attenuated shortfalls for most nutrients. These findings highlight a critical need to support the nutritional requirements for women of childbearing age and pregnant women.
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Affiliation(s)
- Rachel Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Cancer Control Research, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Correspondence: ; Tel.: +1-604-822-1397
| | - Keri Marshall
- Science & Technology, Pharmavite LLC, West Hills, CA 91304, USA
| | - Sandra Zagorin
- Science & Technology, Pharmavite LLC, West Hills, CA 91304, USA
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20
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Cowan AE, Tooze JA, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Potischman N, Bhadra A, Carroll RJ, Bailey RL. Trends in Overall and Micronutrient-Containing Dietary Supplement Use in US Adults and Children, NHANES 2007-2018. J Nutr 2022; 152:2789-2801. [PMID: 35918260 PMCID: PMC9839985 DOI: 10.1093/jn/nxac168] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/19/2022] [Accepted: 07/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dietary supplement (DS) use is widespread in the United States and contributes large amounts of micronutrients to users. Most studies have relied on data from 1 assessment method to characterize the prevalence of DS use. Combining multiple methods enhances the ability to capture nutrient exposures from DSs and examine trends over time. OBJECTIVES The objective of this study was to characterize DS use and examine trends in any DS as well as micronutrient-containing (MN) DS use in a nationally representative sample of the US population (≥1 y) from the 2007-2018 NHANES using a combined approach. METHODS NHANES obtains an in-home inventory with a frequency-based dietary supplement and prescription medicine questionnaire (DSMQ), and two 24-h dietary recalls (24HRs). Trends in the prevalence of use and selected types of products used were estimated for the population and by sex, age, race/Hispanic origin, family income [poverty-to-income ratio (PIR)], and household food security (food-secure vs. food-insecure) using the DSMQ or ≥ 1 24HR. Linear trends were tested using orthogonal polynomials (significance set at P < 0.05). RESULTS DS use increased from 50% in 2007 to 56% in 2018 (P = 0.001); use of MN products increased from 46% to 49% (P = 0.03), and single-nutrient DS (e.g., magnesium, vitamins B-12 and D) use also increased (all P < 0.001). In contrast, multivitamin-mineral use decreased (70% to 56%; P < 0.001). In adults (≥19 y), any (54% to 61%) and MN (49% to 54%) DS use increased, especially in men, non-Hispanic blacks and Hispanics, and low-income adults (PIR ≤130%). In children (1-18 y), any DS use remained stable (∼38%), as did MN use, except for food-insecure children, whose use increased from 24% to 31% over the decade (P = 0.03). CONCLUSIONS The prevalence of any and MN DS use increased over time in the United States. This may be partially attributed to increased use of single-nutrient products. Population subgroups differed in their DS use.
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Affiliation(s)
- Alexandra E Cowan
- Institute for Advancing Health Through Agriculture, Texas A&M University, College Station, TX, USA
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T Dwyer
- NIH Office of Dietary Supplements, Bethesda, MD, USA,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, TX, USA
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Engle-Stone R, Miller JC, Reario MFD, Arnold CD, Stormer A, Lafuente E, Oxley A, Capanzana MV, Cabanilla CVD, Ford JL, Clark A, Velavan TP, Brown KH, Lietz G, Haskell MJ. Filipino Children with High Usual Vitamin A Intakes and Exposure to Multiple Sources of Vitamin A Have Elevated Total Body Stores of Vitamin A But Do Not Show Clear Evidence of Vitamin A Toxicity. Curr Dev Nutr 2022; 6:nzac115. [PMID: 36060221 PMCID: PMC9429969 DOI: 10.1093/cdn/nzac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/14/2022] Open
Abstract
Background Young children exposed to high-dose vitamin A supplements (VAS) and vitamin A (VA)-fortified foods may be at risk of high VA intake and high VA total body stores (TBS). Objectives TBS and estimated liver VA concentration were compared among children with adequate or high VA intake and different timing of exposure to VAS, and associations between estimated liver VA concentrations and biomarkers of VA toxicity were examined. Methods Children 12-18 mo of age (n = 123) were selected for 3 groups: 1) retinol intake >600 µg/d and VAS within the past mo, 2) retinol intake >600 µg/d and VAS in the past 3-6 mo, and 3) VA intake 200-500 µg retinol activity equivalents (RAE)/d and VAS in the past 3-6 mo. Dietary intake data were collected to measure VA intakes from complementary foods, breast milk, and low-dose, over-the-counter supplements. TBS were assessed by retinol isotope dilution, and VA toxicity biomarkers were measured. Main outcomes were compared by group. Results Mean (95% CI) VA intakes excluding VAS were 1184 (942, 1426), 980 (772, 1187), and 627 (530, 724) µg RAE/d, in groups 1-3, respectively; mean VA intake was higher in groups 1 and 2 compared with group 3 (P < 0.05). Geometric mean (GM) (95% CI) TBS were 589 (525, 661), 493 (435, 559), and 466 (411, 528) µmol, respectively. GM TBS and GM liver VA concentrations were higher in group 1 compared with group 3 (liver VA concentration: 1.62 vs. 1.33 µmol/g; P < 0.05). Plasma retinyl ester and 4-oxo-retinoic acid concentrations and serum markers of bone turnover and liver damage did not indicate VA toxicity. Conclusions In this sample, most children had retinol intakes above the Tolerable Upper Intake Level (UL) and liver VA concentrations above the proposed cutoff for "hypervitaminosis A" (>1 µmol/g liver). There was no evidence of chronic VA toxicity, suggesting that the liver VA cutoff value should be re-evaluated. This trial was registered at www.clinicaltrials.gov as NCT03030339.
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Affiliation(s)
- Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jody C Miller
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | | | - Charles D Arnold
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Ame Stormer
- Helen Keller International, Malate, Manila, Philippines
| | | | - Anthony Oxley
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Mario V Capanzana
- Food and Nutrition Research Institute, Department of Science and Technology, Bicutan, Taguig City, Philippines
| | - Carl Vincent D Cabanilla
- Food and Nutrition Research Institute, Department of Science and Technology, Bicutan, Taguig City, Philippines
| | - Jennifer Lynn Ford
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Adam Clark
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Tubingen, Germany
- Vietnamese German Center for Medical Research (VG-CARE), Hanoi, Vietnam
| | - Kenneth H Brown
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Georg Lietz
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Marjorie J Haskell
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, Davis, CA, USA
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22
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Luo H, Dodd KW, Arnold CD, Engle-Stone R. Advanced Dietary Analysis and Modeling: A Deep Dive into the National Cancer Institute Method. J Nutr 2022; 152:2615-2625. [PMID: 36774127 PMCID: PMC9644173 DOI: 10.1093/jn/nxac144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/18/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The National Cancer Institute (NCI) method has been used widely by researchers to make inferences about usual dietary intake distributions of foods and nutrients based on a limited number of 24-h dietary recalls (24-HRs). Although the NCI method does not provide individual estimates of usual intake, it can be used to address many research questions, including modeling effects of nutrition interventions on population distributions of usual intake. Software for implementing the NCI method, and corresponding code examples, is publicly available in the form of SAS macros but little formal guidance exists for conducting advanced analyses. OBJECTIVES We aim to present advanced techniques for working with NCI macros to conduct both basic and advanced dietary analyses and modeling. METHOD We first present the 3 basic building blocks of analyses using the NCI method: 1) data set preparation, 2) application of the MIXTRAN macro to estimate parameters of the usual intake distribution, including effects of covariates, after transformation of 24-HRs to approximate normality, and 3) application of the DISTRIB macro to estimate the distribution of usual nutrient intake. Then, we illustrate how researchers can employ these building blocks to answer questions beyond typical descriptive analyses. RESULTS Researchers can adapt the building blocks to: 1) account for factors such as demographic changes or nutrition interventions such as food fortification, 2) estimate the prevalence of dietary inadequacy via the full probability method, 3) incorporate nutrient intake from sources not always captured by 24-HRs, such as dietary supplements and human milk, and 4) carry out multiple subgroup analyses. This article describes the theoretical basis and operational guidance for these techniques. CONCLUSION With this article as a detailed resource, researchers can leverage the basic NCI building blocks to investigate a wide range of questions about usual dietary intake distribution.
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Affiliation(s)
- Hanqi Luo
- Institute for Global Nutrition, University of California, Davis, CA, USA; Department of Nutrition, University of California, Davis, CA, USA; Hubert Department of Global Health, Rollings School of Public Health, Emory University, Atlanta, GA, USA.
| | - Kevin W Dodd
- National Cancer Institute, NIH, Bethesda, MD, USA
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
| | - Reina Engle-Stone
- Institute for Global Nutrition, University of California, Davis, CA, USA,Department of Nutrition, University of California, Davis, CA, USA
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23
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Taylor VF, Karagas MR. Exposure to arsenolipids and inorganic arsenic from marine-sourced dietary supplements. CHEMOSPHERE 2022; 296:133930. [PMID: 35182530 PMCID: PMC9007862 DOI: 10.1016/j.chemosphere.2022.133930] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 05/05/2023]
Abstract
Dietary supplements sourced from marine environments, such as fish oils and seaweed-based supplements, are widely consumed to boost nutrient intakes, including by vulnerable populations such as pregnant women. Like other marine foods, these supplements are also a potential source of exposure to arsenic, including the known toxic species, inorganic arsenic, and the cytotoxic, lipid-soluble arsenic compounds, arsenic hydrocarbons. A study of 32 marine-sourced supplements found higher total arsenic concentrations (>1000 ng g-1) in supplements made from seaweed, krill and calanus oil, and in fish and fish liver products marketed as "unprocessed". Inorganic arsenic was only detectable in the seaweed samples, and was elevated (8900 ng g-1) in one product. Arsenic hydrocarbons were not detected in krill oil samples but were present at concentrations from 169 to 2048 ng g-1 in "unprocessed" fish and fish liver oil, and calanus oil. Survey data from the New Hampshire Birth Cohort Study (NHBCS) found 13.5% of pregnant women (n = 1997) reported taking fish oil supplements; and of those, most did so daily (75.6%, 6 or more times per week). Only a small percentage (9%) of those who reported consuming fish oil used products associated with higher arsenic levels. Higher urinary arsenic concentrations were found among women who consumed fish oil compared with those who did not, and specifically higher arsenobetaine and dimethyl arsenic concentrations. Dietary supplements are becoming common components of modern diets, and some marine-sourced dietary supplements are a source of inorganic arsenic and arsenic hydrocarbons.
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Affiliation(s)
- Vivien F Taylor
- Department of Earth Science, Dartmouth College, Hanover, NH, USA.
| | - Margaret R Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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24
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Nasreddine LM, Naja FA, Hwalla NC, Ali HI, Mohamad MN, Chokor FAZS, Chehade LN, O'Neill LM, Kharroubi SA, Ayesh WH, Kassis AN, Cheikh Ismail LI, Al Dhaheri AS. Total Usual Nutrient Intakes and Nutritional Status of United Arab Emirates Children (<4 Years): Findings from the Feeding Infants and Toddlers Study (FITS) 2021. Curr Dev Nutr 2022; 6:nzac080. [PMID: 35592517 PMCID: PMC9113371 DOI: 10.1093/cdn/nzac080] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background The transition from a predominantly milk-based diet to a diverse family diet is a window of opportunity for optimal child growth and development. Objectives The 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. Methods A 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. Results Among 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. Conclusions This 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.
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Affiliation(s)
- Lara M Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Farah A Naja
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nahla C Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Habiba I Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Maysm N Mohamad
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Fatima Al Zahraa S Chokor
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Lara N Chehade
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Lynda M O'Neill
- Nestlé Institute of Health Sciences, Nestlé Research Center, Société des Produits Nestlé S.A., Vers-chez-les-Blanc, Lausanne, Switzerland
| | - Samer A Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Wafaa H Ayesh
- Public Health Protection Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - Amira N Kassis
- Whiteboard Nutrition Science, Beaconsfield, Quebec, Canada
| | - Leila I Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Ayesha S Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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25
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Haile D, Brown KH, McDonald CM, Luo H, Jarvis M, Teta I, Ndjebayi A, Martial GAJ, Vosti SA, Engle-Stone R. Applying Zinc Nutrient Reference Values as Proposed by Different Authorities Results in Large Differences in the Estimated Prevalence of Inadequate Zinc Intake by Young Children and Women and in Cameroon. Nutrients 2022; 14:nu14040883. [PMID: 35215534 PMCID: PMC8879783 DOI: 10.3390/nu14040883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/06/2023] Open
Abstract
Nutrient reference values (NRVs) for zinc set by several expert groups differ widely and may affect the predicted prevalence of inadequate zinc intake. We examined this possibility using NRVs published by four different authorities and nationally representative dietary intake data collected among children aged 12–59 months and women in Cameroon. Usual zinc intake was estimated from 24 h recall data using the National Cancer Institute method. Prevalences of total zinc intake below the dietary requirement and of “absorbable zinc intake” below the physiological requirement were estimated using NRVs published by the World Health Organization (WHO), US Institute of Medicine (IOM), International Zinc Nutrition Consultative Group (IZiNCG), and European Food Safety Authority (EFSA). The prevalence of inadequate zinc intake ranged from 10% (IZiNCG—physiological requirement, 95% CI 7–13%) to 81% (EFSA—physiological requirement, 95% CI 78–84%) among children and 9% (WHO—physiological requirement, 95% CI 8–11.0%) to 94% (IOM—physiological requirement, 95% CI 92–95%) among women These differences in the prevalence of inadequate intake translated into sizeable differences in the predicted benefit and cost-effectiveness of zinc fortification programs. Depending on the NRVs applied, assessments differ regarding the need for and design of zinc fortification programs. Efforts are needed to harmonize NRVs for zinc.
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Affiliation(s)
- Demewoz Haile
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
- Correspondence: ; Tel.: +1-530-601-3869
| | - Kenneth H. Brown
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
| | - Christine M. McDonald
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
- Departments of Pediatrics, and Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA 94143, USA
| | - Hanqi Luo
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Michael Jarvis
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
| | - Ismael Teta
- Helen Keller International, Yaoundé 1771, Cameroon; (I.T.); (A.N.)
| | - Alex Ndjebayi
- Helen Keller International, Yaoundé 1771, Cameroon; (I.T.); (A.N.)
| | | | - Stephen A. Vosti
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
- Department of Agricultural and Resource Economics, University of California, Davis, CA 95616, USA
| | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, CA 95616, USA; (K.H.B.); (C.M.M.); (H.L.); (R.E.-S.)
- Institute for Global Nutrition, University of California, Davis, CA 95616, USA; (M.J.); (S.A.V.)
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Cheikh Ismail L, Al Dhaheri AS, Ibrahim S, Ali HI, Chokor FAZ, O’Neill LM, Mohamad MN, Kassis A, Ayesh W, Kharroubi S, Hwalla N. Nutritional status and adequacy of feeding Practices in Infants and Toddlers 0-23.9 months living in the United Arab Emirates (UAE): findings from the feeding Infants and Toddlers Study (FITS) 2020. BMC Public Health 2022; 22:319. [PMID: 35168591 PMCID: PMC8848814 DOI: 10.1186/s12889-022-12616-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/20/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Infant and young child feeding practices (IYCF) impact the early and later health status of the population. Limited data is available regarding IYCF in the United Arab Emirates (UAE). This study aimed to evaluate the nutritional status and adequacy of feeding practices, energy, food, and nutrient intakes of UAE infants and toddlers ages 0-23.9 months. METHODS This study is a population-based cross-sectional survey of 276 infants and toddlers aged 0-23.9 months of which 180 were nationals and 96 were Arab non-nationals living in the UAE. Data were collected from the three major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometry was collected and assessed using WHO Anthro-Survey Analyzer, and a multicomponent age-specific questionnaire was used to evaluate IYCF and sociodemographic characteristics. Usual intake of energy, micronutrients, and macronutrients, including supplements, were collected using multiple-pass 24-h dietary recall and analyzed using the PC-side software. IYCF practices were assessed using the WHO indicators. RESULTS Overall, 4% of children were malnourished, 8% wasted, 15% stunted, 18% at risk of overweight, and 7% overweight and obese. 95% of infants were ever breastfed and 37% exclusively breastfed at 6 months. Around 98% of infants had a timely introduction of complementary food. Macronutrient intake exceeded AMDR for fat, carbohydrates, and protein for 27%, 8% and 2% of toddlers respectively. As for the percentage of those exceeding the ESPGHAN cut-off for free sugars set at 5% of energy intake, 28.6% had excessive intakes overall, 10% in 0-5.9, 21.9% in 6-11.9 and 56.7% in 12-23.9 month. Usual iron intake was below the Estimated Average Requirement (EAR) in 47% of infants 6-11.9 months. Above 12 months, the usual intake of iron and vitamin D were below EAR in 11% and 49% of toddlers respectively. Usual intake exceeded the tolerable upper intake levels (UL) for vitamin A (14 to 18%) and zinc (11 to 22%) across all ages. Approximately 93% of toddlers ages 12-23.9 months did not meet food groups' recommendations for vegetables, 87% for fruits, 48% for milk/dairy, 54% for lean meat and beans, and 33% for grains. CONCLUSIONS This study revealed that a high percentage of infants and toddlers aged 0-23.9 m suffer from a double burden of malnutrition, which is the coexistence of both undernutrition, and overweight and obesity in the same population. In addition to suboptimal feeding practices and inadequate/overconsumption of various nutrients. The findings highlight the need for the development of culturally specific programs aiming to improve the nutritional status of infants and toddlers in the UAE.
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Affiliation(s)
- Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, 27272 United Arab Emirates
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, OX1 2JD UK
| | - Ayesha S. Al Dhaheri
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551 United Arab Emirates
| | - Sarah Ibrahim
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
| | - Habiba I. Ali
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551 United Arab Emirates
| | - Fatima Al Zahraa Chokor
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
| | - Lynda M. O’Neill
- Nestlé Institute of Health Sciences, Nestlé Research Center, Société des Produits Nestlé S.A., Vers-chez-les-Blanc, 1000, 26 Lausanne, Switzerland
| | - Maysm N. Mohamad
- Department of Nutrition and Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 15551 United Arab Emirates
| | - Amira Kassis
- Whiteboard Nutrition Science, Beaconsfield, Quebec, Canada
| | - Wafaa Ayesh
- Public Health Protection Department, Dubai Health Authority, Dubai, United Arab Emirates
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, Lebanon
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27
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Cowan AE, Bailey RL, Jun S, Dodd KW, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Potischman N, Bhadra A, Carroll RJ, Tooze JA. The Total Nutrient Index is a Useful Measure for Assessing Total Micronutrient Exposures Among US Adults. J Nutr 2021; 152:863-871. [PMID: 34928350 PMCID: PMC8891182 DOI: 10.1093/jn/nxab428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most dietary indices reflect foods and beverages and do not include exposures from dietary supplements (DS) that provide substantial amounts of micronutrients. A nutrient-based approach that captures total intake inclusive of DS can strengthen exposure assessment. OBJECTIVES We examined the construct and criterion validity of the Total Nutrient Index (TNI) among US adults (≥19 years; nonpregnant or lactating). METHODS The TNI includes 8 underconsumed micronutrients identified by the Dietary Guidelines for Americans: calcium; magnesium; potassium; choline; and vitamins A, C, D, and E. The TNI is expressed as a percentage of the RDA or Adequate Intake to compute micronutrient component scores; the mean of the component scores yields the TNI score, ranging from 0-100. Data from exemplary menus and the 2003-2006 (≥19 years; n = 8861) and 2011-2014 NHANES (≥19 years; n = 9954) were employed. Exemplary menus were used to determine whether the TNI yielded high scores from dietary sources (women, 31-50 years; men ≥ 70 years). TNI scores were correlated with Healthy Eating Index (HEI) 2015 overall and component scores for dairy, fruits, and vegetables; TNI component scores for vitamins A, C, D, and E were correlated with respective biomarker data. TNI scores were compared between groups with known differences in nutrient intake based on the literature. RESULTS The TNI yielded high scores on exemplary menus (84.8-93.3/100) and was moderately correlated (r = 0.48) with the HEI-2015. Mean TNI scores were significantly different for DS users (83.5) compared with nonusers (67.1); nonsmokers (76.8) compared with smokers (70.3); and those living with food security (76.6) compared with food insecurity (69.1). Correlations of TNI vitamin component scores with available biomarkers ranged from 0.12 (α-tocopherol) to 0.36 (serum 25-hydroxyvitamin D), and were significantly higher than correlations obtained from the diet alone. CONCLUSIONS The evaluation of validity supports that the TNI is a useful construct to assess total micronutrient exposures of underconsumed micronutrients among US adults.
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Affiliation(s)
- Alexandra E Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | | | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Kevin W Dodd
- NIH National Cancer Institute, Bethesda, MD, USA
| | | | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T Dwyer
- NIH Office of Dietary Supplements, Bethesda, MD, USA,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, TX, USA
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Dietary Supplement Use and Interactions with Tamoxifen and Aromatase Inhibitors in Breast Cancer Survivors Enrolled in Lifestyle Interventions. Nutrients 2021; 13:nu13113730. [PMID: 34835986 PMCID: PMC8621720 DOI: 10.3390/nu13113730] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022] Open
Abstract
The use of dietary supplements is common in the general population and even more prevalent among cancer survivors. The World Cancer Research Fund/American Institute for Cancer Research specifies that dietary supplements should not be used for cancer prevention. Several dietary supplements have potential pharmacokinetic and pharmacodynamic interactions that may change their clinical efficacy or potentiate adverse effects of the adjuvant endocrine therapy prescribed for breast cancer treatment. This analysis examined the prevalence of self-reported dietary supplement use and the potential interactions with tamoxifen and aromatase inhibitors (AIs) among breast cancer survivors enrolled in three randomized controlled trials of lifestyle interventions conducted between 2010 and 2017. The potential interactions with tamoxifen and AIs were identified using the Natural Medicine Database. Among 475 breast cancer survivors (2.9 (mean) or 2.5 (standard deviation) years from diagnosis), 393 (83%) reported using dietary supplements. A total of 108 different types of dietary supplements were reported and 36 potential adverse interactions with tamoxifen or AIs were identified. Among the 353 women taking tamoxifen or AIs, 38% were taking dietary supplements with a potential risk of interactions. We observed a high prevalence of dietary supplement use among breast cancer survivors and the potential for adverse interactions between the prescribed endocrine therapy and dietary supplements was common.
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Cowan AE, Jun S, Tooze JA, Dodd KW, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Potischman N, Bhadra A, Carroll RJ, Bailey RL. A narrative review of nutrient based indexes to assess diet quality and the proposed total nutrient index that reflects total dietary exposures. Crit Rev Food Sci Nutr 2021; 63:1722-1732. [PMID: 34470512 PMCID: PMC8888777 DOI: 10.1080/10408398.2021.1967872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A priori dietary indices provide a standardized, reproducible way to evaluate adherence to dietary recommendations across different populations. Existing nutrient-based indices were developed to reflect food/beverage intake; however, given the high prevalence of dietary supplement (DS) use and its potentially large contribution to nutrient intakes for those that use them, exposure classification without accounting for DS is incomplete. The purpose of this article is to review existing nutrient-based indices and describe the development of the Total Nutrient Index (TNI), an index developed to capture usual intakes from all sources of under-consumed micronutrients among the U.S. population. The TNI assesses U.S. adults' total nutrient intakes relative to recommended nutrient standards for eight under-consumed micronutrients identified by the Dietary Guidelines for Americans: calcium, magnesium, potassium, choline, and vitamins A, C, D, E. The TNI is scored from 0 to 100 (truncated at 100). The mean TNI score of U.S. adults (≥19 y; n = 9,954) based on dietary data from NHANES 2011-2014, was 75.4; the mean score for the index ignoring DS contributions was only 69.0 (t-test; p < 0.001). The TNI extends existing measures of diet quality by including nutrient intakes from all sources and was developed for research, monitoring, and policy purposes.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2021.1967872.
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Affiliation(s)
- Alexandra E. Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | | | | | | | | | - Patricia M. Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T. Dwyer
- NIH Office of Dietary Supplements, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Raymond J. Carroll
- Department of Statistics, Texas A&M University, 447 Blocker Building, College Station, TX, USA
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
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Jun S, Cowan AE, Dodd KW, Tooze JA, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Potischman N, Bhadra A, Forman MR, Bailey RL. Association of food insecurity with dietary intakes and nutritional biomarkers among US children, National Health and Nutrition Examination Survey (NHANES) 2011-2016. Am J Clin Nutr 2021; 114:1059-1069. [PMID: 33964856 PMCID: PMC8408856 DOI: 10.1093/ajcn/nqab113] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND 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. OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Alexandra E Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Kevin W Dodd
- National Cancer Institute, NIH, Bethesda, MD, USA
| | - Janet A Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T Dwyer
- Office of Dietary Supplements, NIH, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | | | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Michele R Forman
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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Gahche JJ, Bailey RL. Accurate Measurement of Nutrients and Nonnutritive Dietary Ingredients from Dietary Supplements Is Critical in the Precision Nutrition Era. J Nutr 2021; 151:2094-2095. [PMID: 34293109 DOI: 10.1093/jn/nxab237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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Steffen AD, Wilkens LR, Yonemori KM, Albright CL, Murphy SP. A Dietary Supplement Frequency Questionnaire Correctly Ranks Nutrient Intakes in US Older Adults When Compared to a Comprehensive Dietary Supplement Inventory. J Nutr 2021; 151:2486-2495. [PMID: 34038542 PMCID: PMC8349128 DOI: 10.1093/jn/nxab140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/19/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dietary supplements are commonly taken by adults in the United States and can contribute substantially to daily nutrient intakes. Short supplement-use questionnaires are often used in dietary surveys, but their accuracy has not been well studied. OBJECTIVES The primary objective was to evaluate the accuracy of a short, self-administered supplement frequency questionnaire (SFQ) relative to a comprehensive 1-y inventory of supplement use. A secondary objective was to compare SFQ responses for participants in the intensive measurement study to those from a control group to investigate a possible research participation effect. METHODS The Supplement Reporting study enrolled 1029 older adults in 2005-2006, with a mean age of 67.8 y, who participated in the Multiethnic Cohort and reported regular use of dietary supplements. Of these, 375 were interviewed quarterly to collect detailed information on types and amounts of dietary supplements used, while 654 served as the control group. All participants completed 2 SFQs, 1 y apart. RESULTS Agreement between the 2 instruments in use at least weekly ranged from 88% to 97% for 15 of 16 supplement types, with a lower agreement of 74% for vitamin D. The correlations of nutrient intakes from supplements between the 2 instruments were high, ranging from 0.48 to 0.75, except for iron (r = 0.29). However, mean nutrient intakes as reported on the SFQ were higher than intakes from the inventory for most nutrients, sometimes twice as high. Nutrient intakes based on the SFQ were similar for the inventory and control groups, at both baseline and the end of the study. CONCLUSIONS A self-administered short SFQ can be used in large surveys to identify participants who use 16 categories of dietary supplements at least once a week and can correctly rank participant intakes of nutrients. However, the SFQ does not accurately estimate absolute levels of nutrient intakes from supplements.
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Affiliation(s)
- Alana D Steffen
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Lynne R Wilkens
- Population Sciences in the Pacific–Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Kim M Yonemori
- Population Sciences in the Pacific–Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Cheryl L Albright
- School of Nursing and Dental Hygiene, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Suzanne P Murphy
- Population Sciences in the Pacific–Cancer Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, USA
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Tarasuk V, Brassard D. The effect of consuming voluntarily fortified food and beverages on usual nutrient intakes in the Canadian population. Food Nutr Res 2021; 65:5256. [PMID: 34650396 PMCID: PMC8494267 DOI: 10.29219/fnr.v65.5256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 03/31/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In Canada, regulatory changes have expanded marketing opportunities for voluntarily fortified products (VFPs), with micronutrient additions permitted at levels well in excess of human requirements. OBJECTIVE To examine how the consumption of VFPs relates to usual nutrient intakes in the Canadian population. DESIGN The 2015 Canadian Community Health Survey comprises single 24-h dietary intake recalls on a population-representative sample of 20,487 individuals aged 1 year and older, with second recalls on a subset of 7,608. The intake data included 15 food codes denoting VFP (e.g. energy drinks, fortified beverages, cereals, and bars). We assessed VFP consumption and estimated usual intake distributions for riboflavin, niacin, zinc, and vitamins A, B6, B12, and C for VFP consumers and non-consumers 14-50 years old (n = 8,442) using the National Cancer Institute method. We applied the 'shrink and add' method to estimate usual intakes among supplement users and assessed apparent benefits and risks by comparing usual intake distributions to EARs and ULs. RESULTS Only 2.4% of the population reported any consumption of VFP on the first 24-h recall. VFP consumers were overrepresented in the upper quartile of population intake distributions for niacin, riboflavin, vitamin B6, vitamin B12, and zinc. The median usual intakes of VFP consumers were 24-111% higher than the median usual intakes of non-consumers, and VFP consumers had significantly lower prevalence of inadequacy for riboflavin and vitamins A, B6, B12, and C. Irrespective of VFP consumption, usual intake distributions reached the ULs for vitamin A and zinc with the addition of supplement intakes. DISCUSSION Given the limited differentiation of VFP in this survey, we have likely underestimated nutrient exposure levels. CONCLUSIONS VFP consumption was associated with elevated usual nutrient intakes, but we found limited evidence that it protected consumers from nutrient inadequacies or propelled intakes above tolerable upper levels.
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Affiliation(s)
- Valerie Tarasuk
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Didier Brassard
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, Canada
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Bailey RL, Ard JD, Davis TA, Naimi TS, Schneeman BO, Stang JS, Dewey KG, Donovan SM, Novotny R, Snetselaar LG, de Jesus J, Casavale KO, Pannucci T, Stoody EE. A Proposed Framework for Identifying Nutrients and Food Components of Public Health Relevance in the Dietary Guidelines for Americans. J Nutr 2021; 151:1197-1204. [PMID: 33693925 PMCID: PMC8324230 DOI: 10.1093/jn/nxaa459] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/11/2020] [Accepted: 12/31/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Identification of nutrients of public health concern has been a hallmark of the Dietary Guidelines for Americans (DGA); however, a formal systematic process for identifying them has not been published. OBJECTIVES We aimed to propose a framework for identifying "nutrients or food components" (NFCs) of public health relevance to inform the DGA. METHODS The proposed framework consists of 1) defining terminology; 2) establishing quantitative thresholds to identify NFCs; and 3) examining national data. The proposed framework utilizes available data from 3 key data sources or "prongs": 1) dietary intakes; 2) biological endpoints; and 3) clinical health consequences such as prevalence of health conditions, directly or indirectly through validated surrogate markers. RESULTS In identifying potential NFCs of public health concern, the 2020 DGA Committee developed a decision-tree framework with suggestions for combining the 3 prongs. The identified NFCs of public health concern for Americans ≥1 y old included fiber, calcium (≥2 y old), vitamin D, and potassium for low intakes and sodium, added sugars, and saturated fats (≥2 y old) for high intakes that were associated with adverse health consequences. Iron was identified among infants ages 6-12 mo fed human milk. For reproductive-aged and pregnant females, iron (all trimesters) and folate (first trimester) were identified for low intake, based on dietary and biomarker data (iron) or the severity of the consequence (folic acid and neural tube defects). Among pregnant women, low iodine was of potential public health concern based on biomarker data. Other NFCs that were underconsumed, overconsumed, and pose special challenges were identified across the life course. CONCLUSIONS The proposed decision-tree framework was intended to streamline and add transparency to the work of this and future Dietary Guidelines Advisory Committees to identify NFCs that need to be encouraged or discouraged in order to help reduce risk of chronic disease and promote health and energy balance in the population.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Jamy D Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Teresa A Davis
- USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Tim S Naimi
- Section of General Internal Medicine, Boston University Medical Center, Boston, MA, USA
| | - Barbara O Schneeman
- (Emeritus) Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Jaime S Stang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota—Twin Cities, Minneapolis, MN, USA
| | - Kathryn G Dewey
- (Emeritus) Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Sharon M Donovan
- Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, IL, USA
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaiʻi at Mānoa, Honolulu, HI, USA
| | - Linda G Snetselaar
- Department of Preventive Nutrition Education, University of Iowa, Iowa City, IA, USA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, NIH, US Department of Health and Human Services, Rockville, MD, USA
| | - Kellie O Casavale
- Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, FDA, US Department of Health and Human Services, College Park, MD, USA
| | - TusaRebecca Pannucci
- Center for Nutrition Policy and Promotion, Food and Nutrition Services, USDA, Alexandria, VA, USA
| | - Eve E Stoody
- Center for Nutrition Policy and Promotion, Food and Nutrition Services, USDA, Alexandria, VA, USA
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Oxley A, Engle-Stone R, Miller JC, Reario MFD, Stormer A, Capanzana MV, Cabanilla CVD, Haskell MJ, Lietz G. Determination of Vitamin A Total Body Stores in Children from Dried Serum Spots: Application in a Low- and Middle-Income Country Community Setting. J Nutr 2021; 151:1341-1346. [PMID: 33755155 PMCID: PMC8112776 DOI: 10.1093/jn/nxaa446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/15/2020] [Accepted: 12/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The retinol isotope dilution (RID) method has been used to evaluate vitamin A (VA) status in healthy adults and children in low- and middle-income countries (LMIC) and to assess the efficacy of various VA interventions. OBJECTIVE The study was designed to examine whether dried serum spots (DSS) can be applied to RID when conducting VA total body store (TBS) assessments in community settings. METHODS Four days after an oral dose of 0.4 mg [13C10]retinyl acetate was administered to Filipino children (12-18 mo), a single blood draw was divided to isolate both serum and plasma. Serum (40 μL) was spotted and dried on Whatman 903 cards and shipped at ambient temperature whereas liquid plasma (LP) was frozen at -80°C and shipped on dry ice. The VA tracer to tracee ratio from DSS and LP was quantified by LC-MS/MS. Comparisons between DSS and LP paired samples (n = 72) were made for [13C10]retinol specific activity (SAp) by Pearson's correlation and for VA TBS by Bland-Altman analysis. RESULTS The sum of 3 coextracted DSS were required to consistently detect [13C10]retinol above the LC-MS/MS limit of quantitation (LOQ). [13C10]retinol SAp from DSS was highly correlated with SAp from LP (r = 0.945; P < 0.01). A comparison of methods for TBS determination using Bland-Altman analysis indicated agreement with an intraindividual difference of 24.7 μmol (4.6%). Mean total liver reserve (TLR) values from DSS and LP were 1.7 μmol/g (± 0.6 SD) and 1.6 μmol/g (± 0.6 SD), respectively. CONCLUSIONS VA TBS can be determined from DSS thereby reducing the logistics and cost of maintaining a cold chain by shipping samples at ambient temperature and, thus, making the RID technique more feasible in LMIC community settings. This trial was registered at https://clinicaltrials.gov as NCT03030339.
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Affiliation(s)
- Anthony Oxley
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Reina Engle-Stone
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | - Jody C Miller
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | | | - Ame Stormer
- Helen Keller International, Malate, Manila, Philippines
| | - Mario V Capanzana
- Food and Nutrition Research Institute, Department of Science and Technology, Bicutan, Taguig City, Philippines
| | - Carl V D Cabanilla
- Food and Nutrition Research Institute, Department of Science and Technology, Bicutan, Taguig City, Philippines
| | - Marjorie J Haskell
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, CA, USA
| | - Georg Lietz
- Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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Bailey RL, Jun S. Public Health Decisions Are Made at the Tails of the Distribution: A Novel Tool to Estimate Usual Intake Distributions from Short-Term Dietary Assessment Methods. J Nutr 2021; 151:1059-1060. [PMID: 33847339 PMCID: PMC8112761 DOI: 10.1093/jn/nxab085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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Devarshi PP, Legette LL, Grant RW, Mitmesser SH. Total estimated usual nutrient intake and nutrient status biomarkers in women of childbearing age and women of menopausal age. Am J Clin Nutr 2021; 113:1042-1052. [PMID: 33567452 PMCID: PMC8023996 DOI: 10.1093/ajcn/nqaa392] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/24/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Women of childbearing age (WCBA) and women of menopausal age (WMENO) have distinct nutritional needs. Understanding nutrient intake and status in these life stages is critical for tailoring dietary recommendations. OBJECTIVES The objectives of this study were to evaluate total estimated usual nutrient intakes from food and food plus supplements and to compare these to established recommendations for WCBA and WMENO life stages and examine associations between self-reported estimated usual intakes and nutrient status biomarkers. METHODS Twenty-four-hour dietary recall data from 2011-2016 NHANES were used to estimate usual intake of nutrients from food and food plus supplements for WCBA (aged 15-44 y, n = 4,134) and WMENO (aged 40-65 y, n = 3,438). Estimates of mean usual intake were derived and compared across clinically defined nutrient biomarker categories. RESULTS Both young (aged 15-30 y) and older (aged 31-44 y) WCBA had intakes from food below the Estimated Average Requirement (EAR) for calcium (49% and 44%, respectively), magnesium (62%, 44%), and vitamins A (50%, 44%), C (47%, 46%), D (>97%, >97%), and E (92%, 88%). Similarly, perimenopausal (aged 40-50 y) and menopausal (aged 51-65 y) women had intakes from food below the EAR for calcium (48% and 74%, respectively), magnesium (50%, 49%), and vitamins A (44%, 37%), C (44%, 41%), D (>97%, >97%), and E (88%, 86%). Nutrient gaps decreased with supplement usage. For folate, vitamins D and B-12, and DHA, women in the lowest biomarker category (indicating increased risk of deficiency) had significantly lower intake from food (315.2 ± 25.9 compared with 463.8 ± 5.2 µg dietary folate equivalents, 3.5 ± 0.1 compared with 4.2 ± 0.1 µg, 3.6 ± 0.2 compared with 4.3 ± 0.1 µg, and 0.037 ± 0.005 compared with 0.070 ± 0.006 g, respectively; P < 0.01) of the corresponding nutrient compared with the highest biomarker category. CONCLUSIONS Substantial percentages of WCBA and WMENO are not meeting recommendations for multiple nutrients, whereas supplement usage partially fills nutrient gaps. Dietary intake was positively associated with most nutrient status biomarkers. Specific guidance is needed to ensure adequate nutrient intakes and nutrient status during these critical life stages.
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Affiliation(s)
| | | | - Ryan W Grant
- Science and Technology, Pharmavite, West Hills, CA, USA
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Panjwani AA, Cowan AE, Jun S, Bailey RL. Trends in Nutrient- and Non-Nutrient-Containing Dietary Supplement Use among US Children from 1999 to 2016. J Pediatr 2021; 231:131-140.e2. [PMID: 33340548 PMCID: PMC8005463 DOI: 10.1016/j.jpeds.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 12/11/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To characterize dietary supplement use among US children, including product type, motivations, user characteristics, and trends over time with a primary focus on non-vitamin/non-mineral dietary supplements (NVNM). STUDY DESIGN Overall, NVNM, and vitamin and/or mineral dietary supplement only (VM-only) use; motivations for use; and trends in use over time were examined in children (≤19 years of age) using the National Health and Nutrition Examination Survey 1999-2016 data (n = 42 510). RESULTS Between 1999 and 2016, overall dietary supplement and VM-only dietary supplement use among all children remained relatively stable at ∼30%; yet, NVNM dietary supplement use increased from 2.9% to 6.4%, mainly due to increased use of omega-3 polyunsaturated fatty acids. NVNM use was greater in boys than in girls (3.9% vs 3.3%), and greater in older children than in younger children (Ptrend < .0001), the opposite of what was observed with VM-only dietary supplement use. Although both user groups shared 2 primary motivations, both motivations were reported by a significantly greater percent of vitamin and/or mineral dietary supplement users vs NVNM users: to maintain health (38.7% vs 23.1%) and to improve health (33.1% vs 22.6%). NVNM users were much more likely to use dietary supplement for relaxation, stress, and sleep; for mental health; and for colon and bowel health. CONCLUSIONS Although the prevalence of any dietary supplement and VM-only dietary supplement use among US children has both remained stable, the prevalence of NVNM use has increased substantially over time. Yet, NVNM use remains relatively low overall. NVNM use exhibited different patterns by sex, age, and motivations when compared with vitamin and/or mineral dietary supplement use. Despite increasing NVNM use, high-quality evidence supporting their use is lacking, especially in children.
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Affiliation(s)
- Anita A. Panjwani
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Alexandra E. Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
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Bailey RL. Overview of dietary assessment methods for measuring intakes of foods, beverages, and dietary supplements in research studies. Curr Opin Biotechnol 2021; 70:91-96. [PMID: 33714006 DOI: 10.1016/j.copbio.2021.02.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/26/2021] [Accepted: 02/21/2021] [Indexed: 12/31/2022]
Abstract
Measuring the dietary intakes of individuals for research and monitoring purposes is notoriously challenging and is subject to both random and systematic measurement error. In this review, the strengths and limitations of current methods to assess dietary and supplemental exposures are described. Traditional methods of dietary assessment include food records, food frequency questionnaires, 24-hour recalls, and screening tools; digital and mobile methods that leverage technology are available for these traditional methods. Ultimately, the choice of assessment method is dependent upon the research question, the study design, sample characteristics, and the size of the sample, to name just a few. Despite their challenges, dietary assessment tools are an important dimension of nutrition research and monitoring.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue University, 700 West State St., West Lafayette, IN 47906, United States.
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Luo H, Dodd KW, Arnold CD, Engle-Stone R. Introduction to the SIMPLE Macro, a Tool to Increase the Accessibility of 24-Hour Dietary Recall Analysis and Modeling. J Nutr 2021; 151:1329-1340. [PMID: 33693802 PMCID: PMC8112768 DOI: 10.1093/jn/nxaa440] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/19/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Information on long-term dietary intake is often required for research or program planning, but surveys routinely use short-term assessments such as 24-h recalls (24HRs). Methods to reduce the impact of within-person variation in 24HRs, such as the National Cancer Institute (NCI) method, typically require extensive training and skill. OBJECTIVES We introduce the Simulating Intake of Micronutrients for Policy Learning and Engagement (SIMPLE) macro, a new tool to increase the accessibility of 24HR analysis. We explain the underlying theory behind the tool and provide examples of potential applications. METHODS The SIMPLE macro connects the core NCI statistical code to estimate usual intake distributions and includes additional code to enable advanced analyses such as predictive modeling. The related SIMPLE-Iron macro applies the full probability method to estimate inadequate iron intake, and the SIMPLE-1D macro is used for descriptive or modeling analyses of data with a single 24HR per person. The macros and associated documentations are freely available. We analyzed data from the US National Health and Nutrition Examination Survey (NHANES) and the Cameroon National Micronutrient Survey to compare the SIMPLE macro to 1) the core NCI code using the Estimated Average Requirement cut point method, and 2) the IMAPP software for iron only, and to demonstrate the applications of the SIMPLE macro for estimating usual intake and predictive modeling. RESULTS The SIMPLE macro generates identical results to the core NCI code. The SIMPLE-Iron macro also produces estimates of inadequate iron intake comparable to the IMAPP software. The examples demonstrate application of the SIMPLE macro to 1) descriptive analyses of nutrient intake from food and supplements (NHANES), and 2) analyses accounting for breast-milk nutrient intake and modeling fortification and supplementation programs (Cameroon). CONCLUSIONS The SIMPLE macros may facilitate the analysis and modeling of dietary data to inform nutrition research, programs, and policy.
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Affiliation(s)
- Hanqi Luo
- Address correspondence to HL (e-mail: )
| | - Kevin W Dodd
- National Cancer Institute, NIH, Bethesda, MD, USA
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA,Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Reina Engle-Stone
- Institute for Global Nutrition, University of California, Davis, Davis, CA, USA,Department of Nutrition, University of California, Davis, Davis, CA, USA
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Hoteit M, Zoghbi E, Rady A, Shankiti I, Al-Jawaldeh A. Development of a Lebanese food exchange system based on frequently consumed Eastern Mediterranean traditional dishes and Arabic sweets. F1000Res 2021; 10:12. [PMID: 33708377 PMCID: PMC7931253 DOI: 10.12688/f1000research.27461.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/30/2022] Open
Abstract
Background: The important role of Mediterranean diet was elucidated in various clinical and epidemiological studies underlying its impact on reducing the burden of non-communicable diseases in Mediterranean and non-Mediterranean populations. Objective: The aim of this study was to convert the recipes of the Lebanese traditional dishes into meal planning exchange lists whose items are expressed in grams and adjusted to Lebanese household measures (cups and spoons) that could be used by healthcare professionals. Methodology: Thirty traditional Lebanese dishes were collected in which the carbohydrate, fat and protein were analyzed using Association of Official Analytical Chemists procedures then followed by a calculation of exchange lists of foods per serving using Wheeler method. Results: The variations in macronutrients and fiber content were found among the Lebanese dishes. Carbohydrate was lowest (1.1g/100g) and protein was highest (29.7g/100g) in
Shawarma Dajaj whereas fat content ranged between 0.5 and 22.4 g/100 g in the dishes. For each dish and according to each serving size, carbohydrate, milk (whole milk, reduced fat or skim), fat and protein (lean meat, medium fat meat and high fat meat) exchanges were calculated. Conclusion: This study provides healthcare professionals, dietitians and consumers the chance to proficiently plan traditional-type dishes, ensuring prominent dietetic and medical nutritional therapy practices and patient's self-control.
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Affiliation(s)
- Maha Hoteit
- Faculty of Public Health, Lebanese University, Beirut, Lebanon
| | - Edwina Zoghbi
- World Health Organization Lebanon Country Office, World Health Organization, Beirut, Lebanon
| | - Alissar Rady
- World Health Organization Lebanon Country Office, World Health Organization, Beirut, Lebanon
| | - Iman Shankiti
- World Health Organization Lebanon Country Office, World Health Organization, Beirut, Lebanon
| | - Ayoub Al-Jawaldeh
- World Health Organization Regional Office for the Eastern Mediterranean, World Health Organization, Cairo, Egypt
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Hamulka J, Jeruszka-Bielak M, Górnicka M, Drywień ME, Zielinska-Pukos MA. Dietary Supplements during COVID-19 Outbreak. Results of Google Trends Analysis Supported by PLifeCOVID-19 Online Studies. Nutrients 2020; 13:E54. [PMID: 33375422 PMCID: PMC7823317 DOI: 10.3390/nu13010054] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022] Open
Abstract
The use of dietary supplements (DSs) has been steadily increasing all over the world and additionally, the sales of DSs have dynamical increased in the wake of coronavirus disease 2019 (COVID-19) in most of the countries. We investigated DSs phenomenon in 2020 through (1) exploration of Google searches worldwide and in Poland (with Google Trends (GT) tool), and (2) analyses of results of PLifeCOVID-19 Online Studies conducted during the first and second wave of the pandemic. The conducted GT analysis and cross-sectional studies revealed that during the COVID-19 outbreak in March 2020, the interest in immune-related compounds and foods like vitamins C and D, zinc, omega-3, garlic, ginger, or turmeric, as well as their consumption increased. Improving immunity was the main reason behind the supplementation and changes in consumption of pro-healthy foods. GT analysis has shown these interests were positively correlated with the interest in COVID-19, but adversely with cumulative cases or deaths. Respondents tended to start supplementation during the first COVID-19 wave rather than the second one. Except for the role of vitamins D and C, zinc, and selenium in patients with deficiencies of those nutrients, there are no clear and convincing studies that support the role of DSs use in COVID-19 prevention and treatment in healthy, well-nourished individuals. Moreover, as the risk of elevated intake of some nutrients due to the popularity of DSs exists, effective education of consumers in rationale use of DSs and health-protecting behaviors against COVID-19 should be developed.
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Affiliation(s)
| | | | | | | | - Monika A. Zielinska-Pukos
- Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (SGGW-WULS), 159C Nowoursynowska Street, 02-787 Warsaw, Poland; (J.H.); (M.J.-B.); (M.G.); (M.E.D.)
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Colton KK, Nightingale LM. Influence of cooking skills and nutritional training on dietary choices of incoming chiropractic students. THE JOURNAL OF CHIROPRACTIC EDUCATION 2020; 34:156-163. [PMID: 32338999 PMCID: PMC7682645 DOI: 10.7899/jce-18-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/29/2019] [Accepted: 06/13/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We aimed to identify chiropractic students' cooking skills, perceptions of healthy eating, and influence of prior nutrition training on dietary intake. METHODS Two cohorts of incoming graduate students were surveyed to assess nutritional training prior to matriculation, perceptions of healthy eating behaviors, cooking skills, current dietary intake, and barriers to healthy eating. Using independent t tests, correlations, and descriptive statistics, data from the cohorts were assessed. RESULTS The response rate was 88.7% (n = 178). Nutritional training significantly increased perception of nutritional knowledge and confidence in giving nutrition advice. Completion of at least 1 college nutrition course was associated with nearly double students' weekly fatty fish intake. Males were more likely to eat animal protein, and females preferred desserts. Modeling a healthy diet for future patients was rated as being important, yet most students consumed diets consistent with the typical American diet. The leading barriers to healthy eating included lack of time and money. CONCLUSION Similar to students in other healthcare professions, incoming chiropractic students wish to model healthy behaviors but fail to apply their knowledge and attitudes to their own dietary intakes due to common barriers.
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Omega-3 fatty acid intake and decreased risk of skin cancer in organ transplant recipients. Eur J Nutr 2020; 60:1897-1905. [PMID: 32909136 DOI: 10.1007/s00394-020-02378-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Organ transplant recipients have over 100-fold higher risk of developing skin cancer than the general population and are in need of further preventive strategies. We assessed the possible preventive effects of omega-3 polyunsaturated fatty acid (PUFA) intake from food on the two main skin cancers, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in kidney and liver transplant recipients. METHODS Adult kidney or liver transplant recipients transplanted for at least 1 year and at high risk of skin cancer were recruited from the main transplant hospital in Queensland, 2012-2014 and followed until mid-2016. We estimated their dietary total long-chain omega-3 PUFAs and α-linolenic acid intakes at baseline using a food frequency questionnaire and ranked PUFA intakes as low, medium, or high. Relative risks (RRsadj) of skin cancer adjusted for confounding factors with 95% confidence intervals (CIs) were calculated. RESULTS There were 449 transplant recipients (mean age, 55 years; 286 (64%) male). During follow-up, 149 (33%) patients developed SCC (median 2/person; range 1-40) and 134 (30%), BCC. Transplant recipients with high total long-chain omega-3 PUFA compared with low intakes showed substantially reduced SCC tumour risk (RRadj 0.33, 95% CI 0.18-0.60), and those with high α-linolenic acid intakes experienced significantly fewer BCCs (RRadj 0.40, 95% CI 0.22-0.74). No other significant associations were seen. CONCLUSION Among organ transplant recipients, relatively high intakes of long-chain omega-3 PUFAs and of α-linolenic acid may reduce risks of SCC and BCC, respectively.
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Jun S, Cowan AE, Bhadra A, Dodd KW, Dwyer JT, Eicher-Miller HA, Gahche J, Guenther PM, Potischman N, Tooze JA, Bailey RL. 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. Public Health Nutr 2020; 23:2268-2279. [PMID: 32466808 PMCID: PMC7429309 DOI: 10.1017/s1368980020000257] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE 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. DESIGN Cross-sectional study. SETTING 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. PARTICIPANTS 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. RESULTS 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. CONCLUSIONS Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.
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Affiliation(s)
- Shinyoung Jun
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
| | - Alexandra E. Cowan
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
| | - Anindya Bhadra
- Department of Statistics, Purdue University, 250 N. University St., West Lafayette, IN 47907, USA
| | - Kevin W. Dodd
- National Cancer Institute, National Institutes of Health, Medical Center Drive, Rockville, MD 20850, USA
| | - Johanna T. Dwyer
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD 20892-7517, USA
| | - Heather A. Eicher-Miller
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
| | - Jaime Gahche
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD 20892-7517, USA
| | - Patricia M. Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, 250 South 850 East, Salt Lake City, UT 84112. USA
| | - Nancy Potischman
- Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Bethesda, MD 20892-7517, USA
| | - Janet A. Tooze
- School of Medicine, Wake Forest University, Winston-Salem, NC, 27101, USA
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, 700 W. State St., West Lafayette, IN, 47907, USA
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Haile D, Luo H, Vosti SA, Dodd KW, Arnold CD, Engle-Stone R. 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. Curr Dev Nutr 2020; 4:nzaa132. [PMID: 32908959 PMCID: PMC7467246 DOI: 10.1093/cdn/nzaa132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Voluntarily 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. OBJECTIVES We modeled the impacts of hypothetical micronutrient-fortified biscuits on inadequate micronutrient intake in children and women of reproductive age (WRA) in Cameroon. METHODS In 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. RESULTS Biscuit 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. CONCLUSIONS Given 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.
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Affiliation(s)
- Demewoz Haile
- Department of Nutrition, University of California, Davis, CA, USA
- Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Hanqi Luo
- Department of Nutrition, University of California, Davis, CA, USA
- Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Stephen A Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, CA, USA
| | - Kevin W Dodd
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charles D Arnold
- Institute for Global Nutrition, University of California, Davis, CA, USA
| | - Reina Engle-Stone
- Department of Nutrition, University of California, Davis, CA, USA
- Institute for Global Nutrition, University of California, Davis, CA, USA
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Du M, Luo H, Blumberg JB, Rogers G, Chen F, Ruan M, Shan Z, Biever E, Zhang FF. Dietary Supplement Use among Adult Cancer Survivors in the United States. J Nutr 2020; 150:1499-1508. [PMID: 32101612 PMCID: PMC7269731 DOI: 10.1093/jn/nxaa040] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/09/2019] [Accepted: 02/05/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Many cancer patients initiate dietary supplement use after cancer diagnosis. How dietary supplement use contributes to the total nutrient intake among cancer survivors as compared with individuals without cancer needs to be determined. OBJECTIVES We aimed to evaluate nutrient intakes from dietary supplements among cancer survivors in relation to their total nutrient intake and compare those with individuals without cancer. METHODS We evaluated the prevalence, dose, and reason for using dietary supplements among 2772 adult cancer survivors and 31,310 individuals without cancer who participated in the NHANES 2003-2016. RESULTS Cancer survivors reported a higher prevalence of any (70.4% vs. 51.2%) and multivitamin/mineral (48.9% vs. 36.6%) supplement use and supplement use of 11 individual vitamins and 8 minerals than individuals without cancer. Overall, cancer survivors had significantly higher amounts of nutrient intake from supplements but lower nutrient intakes from foods for the majority of the nutrients. Compared with individuals without cancer, cancer survivors had a higher percentage of individuals with inadequate intake (total nutrient intake <Estimated Average Requirement or Adequate Intake) for folate, vitamin B-6, niacin, calcium, copper, and phosphorus, due to lower intakes of these nutrients from foods. Cancer survivors also had a higher proportion of individuals with excess intake (total nutrient intake ≥Tolerable Upper Intake Level) for vitamin D, vitamin B-6, niacin, calcium, magnesium, and zinc, contributed by higher intakes of these nutrients from dietary supplements. Nearly half (46.1%) used dietary supplements on their own without consulting health care providers. CONCLUSIONS Cancer survivors reported a higher prevalence and dose of dietary supplement use but lower amounts of nutrient intake from foods than individuals without cancer. The inadequate nutrient intake from foods and the short-term and long-term health impact of dietary supplement use, especially at high doses, need to be further evaluated among cancer survivors.
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Affiliation(s)
- Mengxi Du
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Nutrition Department, Dana Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Hanqi Luo
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, Davis, CA, USA
| | - Jeffrey B Blumberg
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Gail Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Fan Chen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Mengyuan Ruan
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Tufts University School of Medicine, Boston, MA, USA
| | - Zhilei Shan
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Emily Biever
- Nutrition Department, Dana Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA,Address correspondence to FFZ (e-mail: )
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Vatanparast H, Islam N, Patil RP, Shafiee M, Whiting SJ. Calcium Intake from Food and Supplemental Sources Decreased in the Canadian Population from 2004 to 2015. J Nutr 2020; 150:833-841. [PMID: 31891395 PMCID: PMC7138660 DOI: 10.1093/jn/nxz318] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/18/2019] [Accepted: 12/03/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND 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. OBJECTIVE We aimed to examine changes in dietary and total usual intake of calcium among Canadians aged ≥1 y over the period 2004-2015. METHODS 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. RESULTS From 2004 to 2015, the usual intake of calcium from food sources significantly decreased in calcium supplement nonusers (from 872 ± 18.2 mg/d to 754 ± 18.0 mg/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%. CONCLUSIONS 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.
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Affiliation(s)
- Hassan Vatanparast
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada,Address correspondence to HV (e-mail: )
| | - Naorin Islam
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
| | - Rashmi Prakash Patil
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
| | - Mojtaba Shafiee
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
| | - Susan J Whiting
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada
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Cowan AE, Jun S, Tooze JA, Dodd KW, Gahche JJ, Eicher-Miller HA, Guenther PM, Dwyer JT, Moshfegh AJ, Rhodes DG, Bhadra A, Bailey RL. Comparison of 4 Methods to Assess the Prevalence of Use and Estimates of Nutrient Intakes from Dietary Supplements among US Adults. J Nutr 2020; 150:884-893. [PMID: 31851315 PMCID: PMC7138661 DOI: 10.1093/jn/nxz306] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/06/2019] [Accepted: 11/21/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Accurate and reliable methods to assess prevalence of use of and nutrient intakes from dietary supplements (DSs) are critical for research, clinical practice, and public health monitoring. NHANES has been the primary source of DS usage patterns using an in-home inventory with a frequency-based DS and Prescription Medicine Questionnaire (DSMQ), but little is known regarding DS information obtained from 24-h dietary recalls (24HRs). METHODS The objectives of this analysis were to compare results from 4 different methods for measuring DS use constructed from two data collection instruments (i.e., DSMQ and 24HR) and to determine the most comprehensive method for measuring the prevalence of use and estimating nutrient intakes from DS for selected nutrients. NHANES 2011-2014 data from US adults (aged ≥19 y; n = 11,451) were used to examine the 4 combinations of methods constructed for measuring the prevalence of use of and amount of selected nutrients from DSs (i.e., riboflavin, vitamin D, folate, magnesium, calcium): 1) DSMQ, 2) 24HR day 1, 3) two 24HRs (i.e., mean), and 4) DSMQ or at least one 24HR. RESULTS Half of US adults reported DS use on the DSMQ (52%) and on two 24HRs (mean of 49%), as compared with a lower prevalence of DS use when using a single 24HR (43%) and a higher (57%) prevalence when combining the DSMQ with at least one 24HR. Mean nutrient intake estimates were highest using 24HR day 1. Mean supplemental calcium from the DSMQ or at least one 24HR was 372 mg/d, but 464 mg/d on the 24HR only. For vitamin D, the estimated intakes per consumption day were higher on the DSMQ (46 μg) and the DSMQ or at least one 24HR (44 μg) than those on the 24HR day 1 (32 μg) or the mean 24HR (31 μg). Fewer products were also classed as a default or reasonable match on the DSMQ than on the 24HR. CONCLUSIONS A higher prevalence of use of DSs is obtained using frequency-based methods, whereas higher amounts of nutrients are reported from a 24HR. The home inventory results in greater accuracy for products reported. Collectively, these findings suggest that combining the DSMQ with at least one 24HR (i.e., DSMQ or at least one 24HR) is the most comprehensive method for assessing the prevalence of and estimating usual intake from DSs in US adults.This trial was registered at clinicaltrials.gov as NCT03400436.
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Affiliation(s)
- Alexandra E Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Janet A Tooze
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kevin W Dodd
- NIH National Cancer Institute, Bethesda, MD, USA
| | | | | | - Patricia M Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT, USA
| | - Johanna T Dwyer
- NIH Office of Dietary Supplements, Bethesda, MD, USA,Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Alanna J Moshfegh
- Beltsville Agricultural Research Center, Agricultural Research Service, USDA, Beltsville, MD, USA
| | - Donna G Rhodes
- Beltsville Agricultural Research Center, Agricultural Research Service, USDA, Beltsville, MD, USA
| | - Anindya Bhadra
- Department of Statistics, Purdue University, West Lafayette, IN, USA
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA,Address correspondence to RLB (e-mail: )
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Jun S, Gahche JJ, Potischman N, Dwyer JT, Guenther PM, Sauder KA, Bailey RL. Dietary Supplement Use and Its Micronutrient Contribution During Pregnancy and Lactation in the United States. Obstet Gynecol 2020; 135:623-633. [PMID: 32028492 PMCID: PMC7138460 DOI: 10.1097/aog.0000000000003657] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the prevalence of use and the micronutrient contribution of dietary supplements among pregnant, lactating, and nonpregnant and nonlactating women in the United States. METHODS Cross-sectional data from 1,314 pregnant, 297 lactating, and 8,096 nonpregnant and nonlactating women (aged 20-44 years) in the 1999-2014 National Health and Nutrition Examination Survey were combined to produce statistically reliable, nationally representative estimates. Information about dietary supplements used in the past 30 days was collected through an interviewer-administered questionnaire and in-home inventory. The prevalence of nutrient-specific supplement use, mean daily nutrient intakes from supplements among users, and motivations for supplement use were assessed. Differences by age, income, and trimester within pregnant women were also tested. RESULTS Seventy-seven percent of pregnant women and 70% of lactating women used one or more dietary supplements, whereas 45% of nonpregnant and nonlactating women used supplements. In particular, 64% of pregnant and 54% of lactating women used prenatal supplements. Mean intakes of thiamin, riboflavin, niacin, folic acid, vitamins B6, B12, and C, iron, and zinc from supplements alone were at or above their respective recommended dietary allowances (RDAs) among pregnant and lactating supplement users. About half of pregnant and 40% of lactating women took supplements based on the recommendation of a health care provider. Among pregnant women, those in their first trimester, aged 20-34 years, or in a lower-income family were less likely to use supplements compared with their counterparts. CONCLUSION The majority of pregnant and lactating women used dietary supplements, which contributed many nutrients in doses above the RDAs. Although inadequate Intakes of folate and iron are of concern among pregnant women who are not using supplements, supplement users often consumed high doses, suggesting a potential need of health care providers to discuss dietary supplement use and the recommended doses of nutrients during pregnancy and lactation.
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Affiliation(s)
- Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN, 47907
| | - Jaime J. Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517
| | - Nancy Potischman
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517
| | - Johanna T. Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892-7517
| | - Patricia M. Guenther
- Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City, UT 84112
| | - Katherine A. Sauder
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN, 47907
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