The Role of Fortified and Enriched Refined Grains in the US Dietary Pattern: A NHANES 2009-2016 Modeling Analysis to Examine Nutrient Adequacy

Consumption of beef sandwiches in the United States and contributions to intake of energy and select nutrients

Introduction

Sandwiches are commonly consumed in the United States. This study summarizes contributions of beef sandwiches to energy and select nutrient intakes.

Methods

Beef sandwiches were categorized as beef burger sandwiches (hamburgers or cheeseburgers) and non-burger beef sandwiches. Per capita and per user consumption of beef sandwiches (total and by type) and contributions to total nutrient intakes from beef and non-beef sandwich components were estimated for the population ages ≥2 years (n = 15,984) participating in WWEIA/NHANES, 2013-2016.

Results

On any given day, 21.4% of the population consumed a beef sandwich. Among all Americans, beef sandwiches provided 6.3% of mean energy intake and accounted for approximately 10% of the population's mean intake of vitamin B12 and saturated fat, 9% of protein and sodium, 7% of iron, 6% of choline, and 5% of potassium. Among beef sandwich consumers, beef sandwiches accounted for 26.2% of mean energy intake on a day of consumption. The beef component of sandwiches accounted for the majority of vitamin B12, choline, and protein, non-beef components accounted for the majority of sodium, iron, and potassium, and beef and non-beef components made similar contributions to saturated fat. Hamburgers provided consumers the lowest energy, sodium, and saturated fat intake, while non-burger sandwiches provided the highest intake of these nutrients.

Discussion

Beef sandwiches are an important source of energy, protein, vitamin B12, iron, and choline, and like other sandwiches, are also a source of sodium and saturated fat. Americans could enhance nutrient contributions from sandwiches by selecting lean meat and limiting use of saturated fat- or sodium-rich non-beef components.

Impact of Plant Protein Intakes on Nutrient Adequacy in the US

There is an increasing interest in plant-based diets and higher levels of plant proteins due to rising concerns around health and environmental sustainability issues. We determined the effects of increasing quartiles of plant protein in the diet on nutrient adequacy using a large nationally representative observational dataset. Twenty-four-hour dietary-recall data from NHANES 2013-2018 from 19,493 participants aged 9+ years were used to assess nutrient intakes. Nutritional adequacy was assessed by estimating the percentage of the population with intakes below the EAR or above the AI. A quartile trend was assessed using regression and the significance was set at Pquartile trend < 0.05. With increasing quartiles of plant protein, the adequacy decreased for calcium, potassium, and vitamin D and increased for copper and magnesium for adolescents. Among the adults aged 19-50 years, the adequacy decreased for protein, choline, selenium, vitamin B12, and zinc and increased for copper, folate, iron, magnesium, thiamin, and vitamin C with increasing quartiles of plant protein. The adequacy for calcium, vitamin A, and zinc decreased and it increased for copper, folate, magnesium, thiamin, and vitamin C with increasing quartiles of plant protein among adults aged 51+ years. The results indicate that diets of mixed protein sources (from both animals and plants) are the most nutritionally adequate.

Effect of increasing plant protein intake on protein quality and nutrient intake of US adults

Three cycles of NHANES (2013-2018) were used to assess protein intake, protein quality (protein digestibility-corrected amino acid score; PDCAAS), protein cost, and nutrient intakes across quartiles of plant protein intake (Q1: <28.2%; Q2: 28.2% to <32.1%; Q3: 32.1 to <36.2%; Q4: ≥36.2%) over a 24 h period (≥19 years, n = 14 888). Grains represented the primary source of plant protein across quartiles and increased from 5.01% (Q1) to 13.5% (Q4). Across all the USDA's Food and Nutrient Database for Dietary Studies (FNDDS) food groups, grains were the most economical source of protein (24.3-26 g protein/$1). Legumes were the most economical plant-based protein (28-37.7 g protein/$1) within the "Protein Foods" FNDDS group. Absolute protein intake (96.6 g/day) and PDCAAS (0.91) of diets were progressively lower from Q1 to 72.0 g/day and 0.8 in Q4, respectively. Modelling the replacement of 50% of amino acids from grains in the diet with amino acids from legumes increased the PDCAAS by 10% in Q4. Intake levels of fibre, folate, iron, and zinc, were higher in Q2-Q4 compared to Q1 but had lower intakes of vitamins B12 and D. Amino acid complementation is required to effectively integrate higher levels plant protein into US diets.

Healthy U.S.-style dietary patterns can be modified to provide increased energy from protein

Background

Dietary patterns developed by the USDA provide modest levels of protein (14–18% energy) within the Acceptable Macronutrient Distribution Range (AMDR) of 10–35% for adults, though diets providing a higher percentage of energy may be beneficial for some individuals. The purpose of this study was to determine if it is feasible to modify the Healthy U.S.-Style Eating Pattern (“HEP”) to provide a higher percentage of energy from protein.

Methods

Using the framework implemented by the USDA in developing the HEP, energy from protein was set at 20%, 25%, and 30%. Amounts of protein foods were proportionally increased while amounts of other foods were adjusted iteratively within specified parameters. The models also disaggregated total meat/poultry into fresh and processed forms to develop patterns maintaining current proportions, current levels, reduced, or no processed meat/poultry. Nutrient intakes were compared with nutrient goals for representative U.S. populations with 2,000 kcal needs (females 19–30 years, males 51–70 years), with 90% of the Recommended Dietary Allowance or Adequate Intake regarded as sufficient.

Results

Dietary patterns with 20% energy from protein were constructed with minor deviations from the current 2,000 kcal HEP. Dietary patterns with 25% energy from protein were constructed for all levels of processed meat/poultry excluding the current proportion model, though relative to the current HEP the constructed patterns reflect substantial reductions in amounts of refined grains and starchy vegetables, and substantial increases in protein foods consumed as beans and peas, seafood, and soy products. It was not possible to develop a pattern with 30% energy from protein without reducing the percentage of energy from carbohydrate below the AMDR or non-compliance with other modeling constraints. Stepwise reductions in processed meat/poultry reduced sodium intake.

Conclusions

It is feasible to develop dietary patterns in a 2,000 kcal diet while mirroring the HEP that meet recommended intakes of nutrients with 20% or 25% energy from protein, though the pattern with 25% energy from protein may be more idealistic than realistic. Reduced levels of processed meat/poultry may translate to lower sodium intake.

Effects of Periodic Religious Fasting for Decades on Nutrient Intakes and the Blood Biochemical Profile

The aim of the present study was to examine differences and correlations in nutrient intakes and serum parameters related to nutrient intake (lipid profile, vitamins, and trace elements) in 200 lifelong Christian Orthodox Church (COC) fasters with periodic abstinence from certain foods (predominantly of animal origin) for approximately half of the year and 200 non-fasting controls, all of whom did not take dietary supplements. Nutrient intakes were assessed through three-day dietary recalls. Blood samples were drawn for the analysis of potential biomarkers of nutrient intake. Fasters had lower energy intake, due to lower fat and protein intake, compared to non-fasters (p < 0.05). Fasters also had lower intakes of vitamins A, B₁, B₂, B₆, B₁₂, D, folate, pantothenate, sodium, calcium, zinc, and phosphorus. Most participants (in both groups) did not meet the recommended dietary allowances of most vitamins and elements. Most serum biochemical parameters did not reflect the differences in nutrient intakes between groups, and none exhibited a correlation coefficient above 0.5 with nutrient intakes. Our findings suggest that COC fasting is associated with reduced intake of many nutrients, although this does not seem to have an impact on the blood biochemical profile.