Sowmyanarayanan V Thuppal

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

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

Correspondence of folate dietary intake and biomarker data

Background: Public health concerns with regard to both low and high folate status exist in the United States. Recent publications have questioned the utility of self-reported dietary intake data in research and monitoring.Objectives: The purpose of this analysis was to examine the relation between self-reported folate intakes and folate status biomarkers and to evaluate their usefulness for several types of applications.Design: We examined usual dietary intakes of folate by using the National Cancer Institute method to adjust two 24-h dietary recalls (including dietary supplements) for within-person variation and then compared these intakes with serum and red blood cell (RBC) folate among 4878 men and nonpregnant, nonlactating women aged ≥19 y in NHANES 2011-2012, a nationally representative, cross-sectional survey, with respect to consistency across prevalence estimates and rank order comparisons.Results: There was a very low prevalence (<1%) of folate deficiency when serum (<7 nmol/L) and RBC (<305 nmol/L) folate were considered, whereas a higher proportion of the population reported inadequate total dietary folate intakes (6%). Similar patterns of change occurred between intakes and biomarkers of folate status when distributions were examined (i.e., dose response), particularly when diet was expressed in μg. Intakes greater than the Tolerable Upper Intake Level greatly increased the odds of having high serum folate (OR: 17.6; 95% CI: 5.5, 56.0).Conclusions: When assessing folate status in the United States, where fortification and supplement use are common, similar patterns in the distributions of diet and biomarkers suggest that these 2 types of status indicators reflect the same underlying folate status; however, the higher prevalence estimates for inadequate intakes compared with biomarkers suggest, among other factors, a systematic underestimation bias in intake data. Caution is needed in the use of dietary folate data to estimate the prevalence of inadequacy among population groups. The use of dietary data for rank order comparisons or to estimate the potential for dietary excess is likely more reliable.

Nutrition in Cardioskeletal Health

Bone and heart health are linked through a variety of cellular, endocrine, and metabolic mechanisms, including the bidirectional effects of mineral-regulating hormones parathyroid hormone and fibroblast growth factor 23. Nutrition plays an important role in the development of both cardiovascular and bone disease. This review describes current knowledge on the relations between the cardiovascular system and bone and the influence of key nutrients involved in mineral metabolism-calcium, vitamin D, and phosphorus-on heart and bone health, as well as the racial/ethnic differences in cardiovascular disease and osteoporosis and the influence that nutrition has on these disparities.

Fiber Intake Varies by Poverty-Income Ratio and Race/Ethnicity in the US Adults

Fiber has been identified as both a ‘shortfall nutrient’ and a ‘nutrient of public health concern.’ However, little is known about dietary fiber intake relative to poverty-income ratio (PIR) and race/ethnicity in US adults. We examined usual intakes of dietary fiber and compliance with the adequate intake (AI) in US adults (≥19 years) using National Health and Nutrition Examination Survey 2011 to 2012 by PIR and race/ethnicity. Among both men and women, significantly higher fiber intake was observed among those in the highest PIR category (men, 22 [SE, 0.8]; women, 18 [SE, 0.6]) compared with those in the lowest category (men, 20 [SE, 0.7]; women, 15 [SE, 0.4]) and the middle category (men, 19 [SE, 0.7]; women, 15 [SE, 0.6]). Although men had higher intake of fiber across all PIR and race/ethnic groups, women had higher prevalence of intake above the AI. Among men, non-Hispanic blacks (17 [SE, 0.8]) had significantly lower intake; whereas among women non-Hispanic blacks (14 [SE, 0.4]) and Hispanic and Mexican Americans (16 [SE. 0.8]) had significantly lower intake compared with the other race/ethnic groups. Asian American women have the highest likelihood of fiber intake that exceeds the AI recommendation. Overall, fiber intake of US adults remains below federal recommendations. Systematic differences in fiber intake occur by PIR and race. Therefore, it is particularly salient to target intervention and education efforts to increase intake of dietary fiber in these groups.

Discrepancy between Knowledge and Perceptions of Dietary Omega-3 Fatty Acid Intake Compared with the Omega-3 Index

Little is known about the relationship between perceptions of nutrient adequacy and biomarkers of nutrition status. This cross-sectional study of U.S. and German adults (n = 200; 18–80 years) compared dietary practices, knowledge, and beliefs of omega-3 fatty acids (O3-FA) with the omega-3 index (O3-I), an erythrocyte-based biomarker associated with cardiovascular disease (CVD) risk. More than half of adults believed that O3-FAs are beneficial for heart and brain health and could correctly identify the food sources of O3-FA. However, the mean O3-I in the U.S. (4.3%) and Germany (5.5%) puts the majority of adults sampled (99%) in intermediate or high CVD-risk categories. More Americans were considered at high CVD-risk (40%) when compared with Germans (10%). In the U.S., but not Germany, women had a significantly higher O3-I than men (4.8% vs. 3.8%, p < 0.001). In the intermediate CVD-risk group, about one-third of adults in both countries (30% in the U.S. and 27% in Germany) believed their diet was adequate in O3-FA. Notably, mean O3-I concentrations did not significantly differ with dietary perceptions of adequacy. More adults in Germany (26%) than in the U.S. (10%) believed that dietary supplements are needed to achieve a balanced diet. In spite of adequate knowledge about food sources and a consistent belief that O3-FA are important for health, very few participants had O3-I concentrations in the range for CVD protection.

No Relationship Between Serum 25(OH) Vitamin D Concentrations and Perceptions of Vitamin D Dietary Intake Adequacy in US and German Adults Not Using Dietary Supplements

Vitamin D plays an important role in bone health, but dietary intakes are below recommendations. The purpose of this cross-sectional study was to compare perceptions of dietary vitamin adequacy with the biomarker of vitamin D exposure [25(OH)D] in two populations with (USA) and without (Germany) fortification among adults not using dietary supplements (n = 200). US adults were more racially diverse and younger, but did not differ with regard to educational attainment, income, UV exposure, or BMI. Mean concentrations were lower, and the prevalence of inadequacy (<20 ng/mL) and suboptimal (<30 ng/mL) 25(OH)D was higher in Germany (23 ng/mL; 70%; 82%) than in the USA (28 ng/mL; 17%; 36%), respectively. Most adults rated vitamin D as important for bone health; but, fewer Germans (22%) than US adults (50%) perceived their diet as adequate. Mean 25(OH)D concentrations and risk of vitamin D inadequacy did not differ by perceptions of dietary adequacy, ratings of a balanced diet, knowledge of vitamin D food sources, or by rankings of importance of vitamin D for health. Fortification with vitamin D in the USA may explain the higher 25(OH) concentrations as UV exposure, and BMI did not differ. Perceptions and knowledge of vitamin D were not related to status in either group.

Poor Dietary Guidelines Compliance among Low-Income Women Eligible for Supplemental Nutrition Assistance Program-Education (SNAP-Ed)

The Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program aims to improve nutritional intakes of low-income individuals (<185% poverty threshold). The objective of this study was to describe the compliance with Dietary Guidelines for Americans (DGA) recommendations for fruits, vegetables, and whole grains among SNAP-Ed eligible (n = 3142) and ineligible (n = 3168) adult women (19–70 years) nationwide and SNAP-Ed participating women in Indiana (n = 2623), using the NHANES 2007–2012 and Indiana SNAP-Ed survey data, respectively. Sensitivity analysis further stratified women by race/ethnicity and by current SNAP participation (<130% poverty threshold). Nationally, lower-income women were less likely to meet the fruit (21% vs. 25%) and vegetable (11% vs. 19%) guidelines than higher-income women, but did not differ on whole grains, which were ~5% regardless of income. The income differences in fruit and vegetable intakes were driven by non-Hispanic whites. Fewer SNAP-Ed-eligible U.S. women met fruit (21% vs. 55%) and whole grain (4% vs. 18%) but did not differ for vegetable recommendations (11% vs. 9%) when compared to Indiana SNAP-Ed women. This same trend was observed among current SNAP participants. Different racial/ethnic group relationships with DGA compliance were found in Indiana compared to the nation. Nevertheless, most low-income women in the U.S. are at risk of not meeting DGA recommendations for fruits (79%), vegetables (89%), and whole grains (96%); SNAP-Ed participants in Indiana had higher compliance with DGA recommendations. Increased consumption of these three critical food groups would improve nutrient density, likely reduce calorie consumption by replacing high calorie choices, and improve fiber intakes.

Validation of a Dietary Screening Tool in a Middle-Aged Appalachian Population

Proactive nutrition screening is an effective public health strategy for identifying and targeting individuals who could benefit from making dietary improvements for primary and secondary prevention of disease. The Dietary Screening Tool (DST) was developed and validated to assess nutritional risk among rural older adults. The purpose of this study was to evaluate the utility and validity of the DST to identify nutritional risk in middle-aged adults. This cross-sectional study in middle-aged adults (45–64 year olds, n = 87) who reside in Appalachia, examined nutritional status using an online health survey, biochemical measures, anthropometry, and three representative 24-h dietary recalls. The Healthy Eating Index (HEI) was calculated to describe overall diet quality. Adults identified by the DST with a nutrition risk had lower HEI scores (50 vs. 64, p < 0.001) and were much more likely to also be considered at dietary risk by the HEI (OR 11.6; 3.2–42.6) when compared to those not at risk. Those at risk had higher energy-adjusted total fat, saturated fat, and added sugar intakes and lower intakes of dietary fiber, and several micronutrients than those classified as not at risk by the DST. Similarly, the at-risk group had significantly lower serum levels of α-carotene, β-carotene, cryptoxanthin, lutein, and zeaxanthin but did not differ in retinol or methylmalonic acid compared with those not at risk. The DST is a valid tool to identify middle-aged adults with nutritional risk.

The Nutritional Status of HIV-Infected US Adults

Abstract Background: Nutrition is critical to HIV mortality and morbidity. Improved treatment modalities have increased life expectancy of HIV-infected individuals. More than 1 million US adults are living with HIV, but little is known about their nutritional status. Objective: We aimed to characterize the nutritional status of those living with HIV with the use of the NHANES 2003–2014. Methods: The NHANES is a nationally representative, cross-sectional survey of the US population and includes a household interview, medical examination, and two 24-h dietary recalls; survey weights are applied to make the data nationally representative. HIV antibodies were ascertained initially by immunoassay and confirmed with Western blot. NHANES 2003–2014 data were analyzed for HIV-positive (n = 87) and HIV-negative (n = 15,868) US adults (aged 19–49 y). Body mass index (BMI), waist circumference, dietary intakes, and nutritional biomarkers were estimated and compared by HIV status, stratified by sex. Results: HIV-infected men and women had higher serum protein, lower serum albumin, and lower serum folate than did non–HIV-infected adults. HIV-positive women had significantly higher BMI, prevalence of overweight or obesity, and waist circumference risk and substantially lower serum 25-hydroxyvitamin D concentrations (44 compared with 65 nmol/L) than did HIV-negative women. When compared with HIV-negative women, HIV-positive women had lower intakes of some key nutrients such as fiber, vitamin E, vitamin K, magnesium, and potassium but had higher intakes of protein and niacin. Conclusions: The NHANES data suggest that HIV infection is associated with poorer markers of some nutritional status indicators; however, the US population prevalence of HIV is <0.5%. Given the small sample size, not only in this study but also in the United States, much more targeted research is needed to better understand the multitude of factors that influence the nutritional status among those living with HIV in the United States, especially among women.