Fortification s Contribution to eeting Dietary Nutrient Recommendations Eric Hentges, PhD ay 17, 2012
Disclosure of interest Currently Executive Director of ILSI North America a non-profit research foundation with major funding from its industry members. Previously Executive Director of USDA s Center for Nutrition Policy and Promotion
Data Development ILSI North America s Fortification Committee initiated and funded the development of data to be presented Data development and analysis conducted by Nutrition Impact, LLC Science Advisor-Johanna Dwyer, DSC, RD, ufts University Gov t Liaison- Regan Bailey, PhD, RD, NIH/ODS
Background Americans are urged to meet nutrient needs through nutrient-dense food sources, while not exceeding energy needs. However, the reality is that many individuals consume diets that are lower in one or more nutrients and higher in energy than recommended.
Research Purpose o determine total usual nutrient intakes of Americans from all sources, as well as to understand the specific nutrient contributions from: Enriched and fortified foods Dietary supplements
General ethodology NHANES 03-04 and 05-06 data were used for dietary intake NCI method was used to estimate usual intakes USDA FNDDS 2.0 and 3.0 and standard release 18 and 20 were used for 03-04 and 05-06 food composition data, respectively* A database was created to separate the amount of intrinsic and added nutrients found in each food
General ethodology Nutrient intake from supplements was determined from the NHANES dietary supplement questionnaire Nutrient composition of supplements were determined using the NCHS dietary supplement database 19 micronutrients were examined
Study One Fulgoni V., Keast D., Bailey R. and Dwyer J. Foods, Fortificants, and Supplements: Where Do Americans Get heir Nutrients? J Nutr. 2011 Oct;141(10):1847-54.
Study Purpose o assess the contributions of micronutrients to usual intakes from all sources (intrinsic to food, fortified and enriched, and dietary supplements) and compare usual intakes to the DRIs for Americans 2 y.
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y Prevalence (%) of Intakes < EAR by source in Americans, ages 2+ y: NHANES 2003-2006 120 Naturally occuring 100 Enriched/Fortified 100 otal (Foods + Supplements) 93 93 91 88 80 74 70 60 60 40 45 34 46 37 25 20 11 8 0 Vitamin A Vitamin D Vitamin E Folate Vitamin C Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
60 Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y 50 40 51 Naturally occuring Enriched/Fortified otal (Foods + Supplements) 30 20 22 10 0 11 12 9 8 6 6 4 2 1.6 1.7 3 1.2 2 hiamin Riboflavin Niacin Vitamin B-6 Vitamin B-12 Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
70 Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y 60 50 59 55 45 Naturally occuring Enriched/Fortified otal (Foods + Supplements) 40 30 20 10 22 7 5 15 11 8 0 agnesium Iron Zinc Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Study One: Conclusions ajor sources of most water soluble vitamins were enrichment/fortification and/or supplements ajor sources of most minerals (except for iron) were intrinsic to foods Fortification/enrichment plays an important role in increasing the % of population >EAR for vitamins A, thiamin, folate, and iron
Study One: Conclusions Supplements increase the % of the population meeting the EAR especially for nutrients that are not prevalent in foods (vitamins D and E) Supplements also increase the % > UL
Study One: ake home ost Americans met recommended nutrient target for the majority (but not all) of vitamins and minerals evaluated However.. far fewer individuals would have done so without intakes of enriched and fortified foods and even fewer if dietary supplements are excluded
Studies wo and hree Bailey RL, Fulgoni VL, Keast DR, Dwyer J. Dietary supplement use is associated with higher intakes of minerals from food sources. Am J Clin Nutr. 2011 Nov;94(5):1376-81. Bailey RL, Fulgoni VL, Keast DR, Dwyer J. Examination of Vitamin Intakes among US Adults by Dietary Supplement Use. J Acad Nutr Diet. 2012;112:657-663.
Dietary Supplement Use Over ime in the U.S. 1999-2008 (n=44,137) 60 53 51 50 53 50 47 51 40 30 20 10 0 35 31 32 33 31 1-18 years 19+ years 99-00 01-02 03-04 05-06 07-08 Overall Data Source: National Heath and Nutrition Examination Survey, 1999-2008 32
Purpose (both studies combined) o assess the vitamin and mineral intakes of adults from the diet by supplement-use categories, and how these supplements contributed to meeting or exceeding DRIs for selected micronutrients.
Users versus Non-users Defined Users: those who reported taking at least one dietary supplement within the previous 30 days Diet: food sources only otal intakes: diet + supplements Non-users: no supplement use Diet: food sources only
Nutrient Intakes Intakes from from Foods Food Sources Sources Only Only ales users had higher intakes than non-users Folate Vitamin A Vitamin E Vitamin K agnesium Potassium Copper Selenium Females users had higher intakes than non-users Folate Vitamin A Vitamin C Vitamin D Vitamin E Calcium Iron agnesium Zinc Phosphorus Copper Potassium
% of Adults with Intakes < EAR by Supplement Use 70 60 66 Non-users Users 50 51 40 30 20 21 20 20 20 13 10 0 0.1 0.3 0.6 Calcium agnesium Copper Zinc Iron Bailey RL, Fulgoni VL, Keast DR, Dwyer.J. J Acad Nutr Diet. 2012;112:657-663.
% of Adults with Intakes < EAR by Supplement Use 100 96 96 80 Non-users Users 60 40 48 58 25 20 0 14 1 3 2 5 Folate Vitamin C Vitamin A Vitamin D Vitamin E Bailey RL, Fulgoni VL, Keast DR, Dwyer J.American Journal of Clinical Nutrition, 2011;94:1376 81.
% of adult of dietary supplement users who exceed the UL by gender 14 12 12.1 11.2 ales Females 10 8 7 7.3 7.2 7.2 6 4 4.5 3.6 2 0 Calcium Iron Zinc agnesium Bailey RL, Fulgoni VL, Keast DR, Dwyer J. American Journal of Clinical Nutrition, 2011;94:1376 81.
% of adult of dietary supplement users who exceed the UL by gender 8 7 6 6.3 7.5 ales Females 5 4 3 2.8 3.3 3 3.9 2 1 1.6 1.6 0 Folic Acid Vitamin A Vitamin B-6 Vitamin C Bailey RL, Fulgoni VL, Keast DR, Dwyer.J. J Acad Nutr Diet. 2012;112:657-663.
Studies wo and hree: Conclusions Adults who use dietary supplements tend to have higher mineral and vitamin intakes from foods than non-users Supplements help users meet the EAR for all micronutrients (except potassium) his is especially true for nutrients that are not prevalent in foods (e.g. vitamin D, vitamin E) Non-users had significantly higher prevalence of intakes below the EAR Supplement use also creates the potential for intakes above the UL for some nutrients (folic acid, vitamins A, B-6 and C and calcium, iron, zinc and magnesium)
Studies wo and hree: ake Home ore than half of adults use dietary supplements in the U.S. Dietary habits of supplement users and nonusers are different Supplement use is associated with a greater percentage of individuals exceeding the UL for some nutrients
Study Four Bailey RL, Fulgoni VL, Keast DR, Lentino CV, DwyerJ. Do dietary supplements improve micronutrient sufficiency in U.S. children and adolescents? J of Pediatrics, in press.
Purpose o assess whether micronutrient supplements given to children help fill gaps in nutritionally inadequate diets or whether they contribute to already adequate diets and contribute to excessive micronutrient intakes from foods.
Bailey et al., J of Pediatrics, in press. % of Children with Intakes < EAR by Supplement Use 87 83 80 Non-users Users 60 50 40 35 37 31 30 20 20 18 21 6 9 9 0 1 2 2
% of Children with Intakes > UL by Supplement Use 60 52 50 Non-users 49 45 40 Users 30 20 17 18 10 0 6 5 3 3 0 Iron (mg) Zinc (mg) Copper (mg) Folate (DFE) Vitamin A (RAE) Bailey et al., J of Pediatrics, in press.
Studies Four: Conclusions Summary of Supplement Use: Children s Data No differences in the vitamin or mineral intakes from food sources between users and non-users Different than adults Higher % of users meet the EAR, particularly for vitamin D and E Similar to adults Users have higher prevalence of intakes > UL Both children and adult users have excessive intakes of iron, zinc, folic acid, and vitamin A (retinol).
Next Steps Food Sources Paper What foods are providing micronutrients? Examining the Nutrition Facts Panel Scenarios How may changes in DV change nutrient intakes?
Federal Register 11/2/07 If the basis for calculating %DV changes would some products or categories be reformulated or re-labeled in order to make a claim? Do you have any information suggesting that changes in nutrient intakes and consumption behavior will result from newly reformulated or newly labeled products to make these claims?
hank you! Eric Hentges, PhD