Iron and zinc status in multiple sclerosis patients with pressure sores

Measurements of weighted dietary intakes and plasma determinations of albumin, iron, zinc, ascorbic acid and TIBC were carried out on twenty female multiple sclerosis patients in a long-stay hospital for disabled people. The group included ten patients with a recent history of pressure sores, closely matched with ten patients without pressure sores. Mean daily intake of carbohydrate was found to be higher in the non-pressure sore group whilst intake of zinc was lower in this group. Intakes of all other nutrients were comparable between the two groups. For both groups, intakes of energy, folate, vitamin D, iron and zinc were less than recommended values. Mean plasma levels of albumin and iron were towards the lower limit of the normal range, whilst that for zinc was considerably less than the normal range. Plasma TIBC was slightly above the normal range. Levels of plasma iron and zinc were significantly lower in the pressure sore group. The data indicate that severely disabled hospitalized patients with multiple sclerosis may be at risk of poor nutritional status. The results suggest that in the presence of pressure sores, there are increased requirements for specific nutrients, notably zinc and iron. Consideration is given to the possible value of supplementation of these individuals.     

Evaluation of folate status by serum and erythrocyte folate levels and dietary folate intake in Taiwanese schoolchildren

The folate status and dietary folate intake of Taiwanese schoolchildren was investigated by analysis of both serum and red blood cell (RBC) folate levels and dietary folate intake in 1105 boys and 958 girls aged 6-13 years sampled from the Nutrition and Health Survey in Taiwan Elementary School Children 2001-2002 (NAHSIT Children 2001-2002). Mean serum folate levels were 18.3+/-8.8 nmol/L (8.1+/-3.9 ng/mL) in boys and 20.3+/-9.7 nmol/L (9.0+/-4.3 ng/mL) in girls. Mean RBC folate levels were 700+/-320 nmol/L (308+/-141 ng/mL) in boys and 751+/-347 nmol/L (331+/-153 ng/mL) in girls. The prevalence of serum folate deficiency was 1.4% in boys and girls, and the prevalence of marginal serum folate deficiency (7-14 nmol/L) was 31.1% in boys and 25.8% in girls. In addition, 8.5% of boys and 7.4% girls had RBC folate deficiency (RBC folate < 318 nmol/L), and 17% of children had marginal RBC folate deficiency (RBC folate of 318-454 nmol/L). Our results suggesting that Taiwanese schoolchildren have poor folate status especially during periods of rapid growth and development such as the transition from childhood to early adolescence (boys at age 12-12.9, girls at age 11-12.9). The average estimated folate intakes were 269+/-9 microg/d in boys and 259+/-9 microg/d in girls, and 42% of Taiwanese schoolchildren had a dietary folate intake below 2/3 of the RDA, indicating a poor dietary folate intake in this population. This study shows that the folate status of Taiwanese schoolchildren is currently inadequate and strategies are needed for improvement.     

Supplement use: is there any nutritional benefit?

OBJECTIVE: To examine the role of dietary supplements in improving total nutrient intakes in adults. DESIGN: Dietitian-administered 24-hour recalls (of intake including supplements) were conducted in 1997 and 1998. Supplement users were categorized into groups based on the types of supplements used and nutrient intake was examined. SUBJECTS: Using a multistage, stratified random sampling, 1,530 Canadian adults aged 19 to 65 years were surveyed. STATISTICAL ANALYSES PERFORMED: Intakes from diet, supplements, and diet plus supplements were examined by age/gender stratification. RESULTS: Supplement users had dietary intakes, from food alone, similar to nonusers with mean intakes in some age/sex groups below the Recommended Daily Allowance (RDA)/Adequate Intake (AI) for iron, calcium, and folate. Multivitamin users had mean intakes (from diet plus supplement) of folate above the RDA and iron intakes also increased to RDA levels among women aged 19 to 50 years. Calcium supplement users had lower calcium and vitamin D intakes than nonusers from diet alone in some age/sex groups. Calcium tablets increased mean calcium intakes to AI levels among all age/sex groups. Many supplement users exceeded the new Upper Limits of safe intake; 47% in the case of niacin. APPLICATIONS: Supplements are commonly used and can help some persons adhere to Dietary Reference Intake recommendations concerning intake of folate, calcium, vitamin D. and iron. We found multivitamin users to have higher total intakes of folic acid, iron, calcium, and vitamin D. Also, targeted use of calcium supplements effectively enhanced intakes. However, concurrent vitamin D supplementation is important and awareness of product composition with respect to Upper Limits is essential.     

Folate nutriture in pregnancy

Folacin intakes from diet and supplements consumed during pregnancy were determined by interview in 566 women. Eight percent of this population (48 women) obtained folacin from diet only. Thirteen percent (76 women) received less than two-thirds of the RDA for folacin for pregnant women. Serum and erythrocyte folate levels in maternal and cord blood were correlated with dietary folacin intakes in subsamples of the group. Women who received their folate from diet alone showed marginal or deficient maternal serum folate levels. Of the group of women whose folacin intake was equal to or greater than the RDA for pregnant women, some had intakes as high as eight times the RDA from supplements. When, in a subsample, total folacin intake was correlated with maternal and cord folate levels, significant correlations were obtained. The high serum and erythrocyte folate levels resulting from self-medication with folate supplements are of concern because of possible deleterious interaction with other nutrients.     

Evidence for diminished B12 absorption after gastric bypass: oral supplementation does not prevent low plasma B12 levels in bypass patients.

Vitamin and mineral assays were performed on blood in 20 gastric bypass patients preoperatively and 6 and 12 months postoperatively. Values were compared with serial food records in nine patients. Postoperatively, all patients were prescribed a supplement containing the recommended dietary allowances (RDA) for vitamins and minerals. Weight, calorie and protein intake, and total serum protein decreased over the study interval (p less than 0.01). Dietary intakes of vitamins B1, B2, B6, folate, iron and zinc fell (p less than 0.01), but total intake (i.e., diet + supplement) did not decrease with the exception of iron. Blood indicators of these nutrients were normal preoperatively and did not decline. However, plasma vitamin B12 levels decreased from 385 pg/ml preoperatively to 234 pg/ml at 1 year (p = 0.0064), despite an increase in total vitamin B12 intake from 2.6 to 11.7 micrograms/day (p = 0.1173). Five patients (27.8%) had abnormally low plasma vitamin B12 levels at 1 year postoperatively; four were taking at least the RDA for vitamin B12 as supplements. Although oral supplementation containing the RDA for micronutrients can prevent abnormal blood indicators of most vitamins and minerals, it is insufficient to maintain normal plasma B12 levels in about 30% of gastric bypass patients.     

Evidence for diminished B12 absorption after gastric bypass: oral supplementation does not prevent low plasma B12 levels in bypass patients.

Vitamin and mineral assays were performed on blood in 20 gastric bypass patients preoperatively and 6 and 12 months postoperatively. Values were compared with serial food records in nine patients. Postoperatively, all patients were prescribed a supplement containing the recommended dietary allowances (RDA) for vitamins and minerals. Weight, calorie and protein intake, and total serum protein decreased over the study interval (p less than 0.01). Dietary intakes of vitamins B1, B2, B6, folate, iron and zinc fell (p less than 0.01), but total intake (i.e., diet + supplement) did not decrease with the exception of iron. Blood indicators of these nutrients were normal preoperatively and did not decline. However, plasma vitamin B12 levels decreased from 385 pg/ml preoperatively to 234 pg/ml at 1 year (p = 0.0064), despite an increase in total vitamin B12 intake from 2.6 to 11.7 micrograms/day (p = 0.1173). Five patients (27.8%) had abnormally low plasma vitamin B12 levels at 1 year postoperatively; four were taking at least the RDA for vitamin B12 as supplements. Although oral supplementation containing the RDA for micronutrients can prevent abnormal blood indicators of most vitamins and minerals, it is insufficient to maintain normal plasma B12 levels in about 30% of gastric bypass patients.     

Association between dietary folate-rich food intake and folate status of elderly Taiwanese

To investigate the relationship between folate status and dietary folate intake in the Taiwanese elderly, we analyzed plasma folate levels and dietary folate intake in 725 males and 705 females aged 65-90 years, sampled from the Elderly Nutrition and Health Survey in Taiwan (1999-2000) (Elderly NAHSIT). Results showed that the mean plasma folate levels were 22.9+/-1.4 nmol/L (10.1+/-0.6 ng/ml) for males and 29.5+/-1.6 nmol/L (13.0+/-0.7 ng/ml) for females. The average plasma folate concentrations of males from all age groups were significantly lower than those of females (P<0.0001). None of the study subjects had a plasma folate below 7 nmol/L (3 ng/ml). However, 18.6% of males and 12.1% of females had marginal folate deficiency, with plasma folate between 7-14 nmol/L (3-6 ng/ml). This suggests that elderly males have a poorer folate status than elderly females in the Taiwanese population. The percentage of marginal folate deficiency tended to increase with age among females (P trend=0.0137). The average estimated folate intakes were 379+/-18 microg/d in males and 351+/-27 microg/d in females. However, 45.5% of males and 48.8% of females had a dietary folate intake below 2/3 of the RDA of 400 microg/d. Our results indicated that dietary folate intake is positively correlated with plasma folate levels (r=0.10, P<0.05). In addition, dietary folate intake increased with increased intakes of vegetables, mushrooms and fruit. A lower intake of fruit appeared to be responsible for the higher prevalence of marginal folate deficiency among females over the age of 80 years.     

Vitamin B-12 and folate intakes and plasma levels of black adolescent females

The vitamin B-12 and folate intakes and plasma levels of 39 healthy black female adolescents were evaluated. Estimated dietary folate intakes of 97% of the subjects were less than 2/3 of the RDA, and 74% had plasma folate levels indicative of marginal (3.0 to 5.9 ng/ml [less than 6 nmol/:]), nmol/L]), and 3%, deficient (below 3.0 ng/ml [less than 6 nmol/L]) folate status. Thirteen percent of the subjects had estimated dietary intakes below 2/3 of the RDA for vitamin B-12; all subjects had plasma levels indicative of adequate vitamin B-12 status.     

Nutritional survey of highly trained women runners

Mean daily intakes from 3-day dietary records for calories, energy-providing nutrients, and selected minerals were calculated for 51 highly trained women runners. Selected blood constituents relating to mineral status were also measured. Intakes of calcium, magnesium, iron, and copper were above the amounts recommended by the National Research Council whereas zinc intake was below the recommended dietary allowances (RDA). Caloric intakes, although above the RDA for sedentary women, appeared low for women running 10 miles/day. Concentrations of serum ferritin and plasma zinc were indicative of marginal iron and zinc status in many of the women. Whether the nutrient content of the diets consumed by these women is adequate relative to energy output or whether training lowers nutrient requirements by enhancing metabolic efficiency will require further investigation.     

Dietary iron deficiency and sports anaemia.

In order to determine whether dietary inadequacies can explain the sub-optimal iron status widely documented in endurance-trained athletes, the food intake records of Fe-deficient and Fe-replete distance runners and non-exercising controls of both sexes were analysed. In all the male study groups the mean dietary Fe intake met the recommended dietary allowances (RDA; > 10 mg/d (US) Food and Nutrition Board, 1989). However, both female athletes and controls failed to meet the RDA with regard to Fe (< 15 mg/d) and folate (< 200 micrograms/d). There was no difference in the total Fe intakes of Fe-deficient and Fe-replete athletes and the controls of each sex. However, Fe-deficient male runners, but not female runners, consumed significantly less haem-Fe (P = 0.048) than their comparative groups. This suggests that the habitual consumption of Fe-poor diets is a factor in the aetiology of athletes' Fe deficiency.     

Folate intakes and folate biomarker profiles of pregnant Japanese women in the first trimester

OBJECTIVE: To assess the status of dietary folate intake, serum and red blood cell (RBC) folate, and related nutritional biomarkers in healthy Japanese women in early pregnancy. DESIGN: A cross-sectional, observational study. SUBJECTS: Pregnant women in the first trimester, at 7-15 weeks gestation (n=70), who were not consuming any folate supplements or folate fortified foods. METHODS: Three-day dietary records were obtained from each subject to assess dietary folate intake. Blood samples were collected for measurement of biomarkers. Biomarkers and nutrient intake were analyzed in two groups defined by their serum folate concentrations: the low folate group (serum folate < 9 ng/ml) and the high folate group (serum folate > or = 9 ng/ml). RESULT: Mean serum and RBC folate concentrations in all subjects were 10.3 and 519 ng/ml, respectively. These levels were remarkably higher than the reported values from many other countries despite our subjects receiving no folic acids supplements. However, mean folate intake by our subjects from natural foods was 289 microg/day, which is thought to be low according to the Japanese dietary recommendation specified for pregnant women. The intake of spinach and fruits was significantly greater in the high folate group than in the low folate group. CONCLUSION: Folate intake was thought to be adequate to maintain a desirable level of serum folate concentration in Japanese pregnant women in the first trimester, although the intake of folate from natural food was not high enough to meet the recommended daily intake.     

Folate intake at RDA levels is inadequate for Mexican American men with the methylenetetrahydrofolate reductase 677TT genotype

Since the establishment of the 1998 folate recommended dietary allowance (RDA), the methylenetetrahydrofolate reductase (MTHFR) 677C-->T variant has emerged as a strong modifier of folate status. This controlled feeding study investigated the adequacy of the RDA, 400 microg/d as dietary folate equivalents (DFE), for Mexican American men with the MTHFR 677CC or TT genotype. Because of the interdependency between folate and choline, the influence of choline intake on folate status was also assessed. Mexican American men (n = 60; 18-55 y) with the MTHFR 677CC (n = 31) or TT (n = 29) genotype consumed 438 microg DFE/d and total choline intakes of 300, 550 (choline adequate intake), 1100, or 2200 mg/d for 12 wk. Folate status response was assessed via serum folate (SF), RBC folate, plasma total homocysteine (tHcy), and urinary folate. SF decreased (P < 0.001) 66% to 7.9 +/- 0.7 nmol/L (means +/- SEM) in men with the 677TT genotype and 62% to 11.3 +/- 0.9 nmol/L in the 677CC genotype. Plasma tHcy increased (P < 0.0001) 170% to 31 +/- 3 micromol/L in men with the 677TT genotype and 18% to 11.6 +/- 0.3 micromol/L in the 677CC genotype. At the end of the study, 34% (677TT) and 16% (677CC) had SF concentrations <6.8 nmol/L and 79% (677TT) and 7% (677CC) had tHcy concentrations >14 micromol/L. Choline intake did not influence the response of the measured variables. These data showed that the folate RDA is not adequate for men of Mexican descent, particularly for those with the MTHFR 677TT genotype, and demonstrated a lack of influence of choline intake on the folate status variables measured in this study.     

The nutrient intakes of pregnant and lactating mothers of good socio-economic status in Cambridge, UK: some implications for recommended daily allowances of minor nutrients

1. Forty-two mothers from social classes I, II and III non-manual and twenty-one from social classes III manual M), IV and V were studied longitudinally. The mean daily nutrient intakes in months 4-9 of pregnancy, months 2-4 of lactation and 3 and 6 months post-lactation are presented and are compared with the UK and the US recommended daily allowances (RDA). 2. The quality of the diets (nutrients per 4184 kJ (1000 kcal] was found to be better than that of other adult female populations studied in the UK, except for a group of dietitians. 3. The mean daily intakes of nutrients for which there are UK RDA were almost all greater than 100% of the RDA. The exceptions were iron, which in the manual group (social classes IIIM, IV and V) was 85% of the RDA in pregnancy and 75% post-lactation, and vitamin D. 4. Among the nutrients for which there are US, but not UK RDA, only phosphorus and vitamin B12 intakes were greater than 100% of the RDA in both groups at all stages of the study. Intakes of other nutrients were below the RDA: pantothenate 70-91, vitamin B6, zinc, vitamin E and copper 40-72, folate 21-44, and biotin less than 20% of the RDA. 5. The bases of the RDA for adult women were examined; for most nutrients the information is limited. It was concluded that the RDA for magnesium, vitamin E and pantothenate are probably higher than necessary and that deficiency is unlikely; that zinc, copper, vitamin B6 and folate are probably 'marginal' nutrients for 'at risk' groups; and that information on biotin is insufficient even roughly to assess the dietary requirement.     

Nutritional status of non-institutionalized elderly Alabamians

Nutritional status of 58 noninstitutionalized elderly persons from rural Alabama was assessed. All sex-race groups had mean energy and nutrient (protein, calcium, iron, vitamins A, B1. B2, C and niacin) intakes greater than two-thirds RDA with the exception of folate. White females had excessive energy consumption, but black women had the highest mean body mass index and hypertension. Forty-five percent of the subjects had serum folate levels <6ng/ml, and values showed a significant correlation with dietary folate intake and hemoglobin values.     

Changes in vitamin and mineral intakes and serum concentrations among free-living men on cholesterol-lowering diets: the Dietary Alternatives Study

Nutritional adequacy of diets with 18-30% of calories from fat was investigated in men with elevated serum cholesterol (n = 396) at the end of diet classes and 1 and 2 y later. On 4-d food records, intakes of vitamin A, beta-carotene, folate, vitamin C, magnesium, vitamin B-6, iron, thiamin, and riboflavin increased from baseline whereas niacin, selenium, vitamin E, and zinc decreased. Median zinc intake, 80% of the recommended dietary allowance (RDA) at baseline, decreased to approximately 75% of the RDA, most markedly when intakes of meat, fish, and poultry were limited to 85 g/d. Nutrient densities generally increased. Of the serum nutrients measured, median beta-carotene and vitamin C increased, whereas vitamin B-6, iron, and zinc were unchanged. Below-normal values were fewer for vitamin C and magnesium. Diets similar to the National Cholesterol Education Program Step-Two Diet [less than 7% saturated fatty acids, less than 200 mg cholesterol/d] appeared to provide increased levels of most micronutrients both short and long term to men receiving comprehensive dietary counseling.     

Nutritional status of vitamin A, E, C, B1, B2, B6, nicotinic acid, B12, folate, and beta-carotene in young women

To investigate the vitamin status of young Japanese women, dietary intakes of vitamin A, E, C, B1, B2, B6, B12, niacin, folate, and beta-carotene were assessed by a 3-d weighed food record in 150 female students aged 21-22. Whole blood levels of vitamin B1, B2, and nicotinic acid, and serum levels of retinol, alpha-tocopherol, vitamin B6, and beta-carotene were determined by HPLC. Vitamin B12 and folate in serum were measured by chemiluminescence immunoassay, and serum vitamin C was done by dinitrophenylhydrazine method. When the 6th revision RDAs for the Japanese (physical activity level 1) were applied, 46.7% of the females showed sufficient intake for vitamin A, 28.7% for E, 80.7%, for B1, 92.7% for B2, 54.7% for B6, 99.3% for niacin, 76.0% for B12, 34.0% for folate, and 54.0% for C. Fifty-nine percent of total vitamin A (microgRE) intakes were derived from beta-carotene. The mean+/- SD of energy intakes was low, 1.572+/-315 kcal. Significant correlations among intakes of energy and all these vitamins were found. Serum folate and ascorbic acid levels in the females with corresponding vitamin intakes above the RDA were significantly higher than in those with intakes below the RDA. There were significant correlations between blood vitamin levels and vitamin intakes in vitamin B12 (r=0.185), folate (r=0.255), vitamin C (r=0.272), and beta-carotene (r=0.319). Mean blood levels of folate, ascorbic acid, vitamin B2, B12, and beta-carotene were higher in the highest quartile of intake than in the lowest. The 95% confidence intervals of blood vitamin levels obtained from the females with sufficient vitamin intakes were nearly equal to those obtained from all subjects. Only a few females (0.7-4.7%) had their blood vitamin levels below the lower limits. Serum alpha-tocopherol levels were significantly correlated with serum levels of retinol, beta-carotene, and vitamin C. This data suggested that young women should increase suitable dietary food intakes in order to maintain good status of vitamin. Moreover, sufficient amount of physical activity would be expected for prevention of excessive energy intake.     

Diet, serum homocysteine levels and ischaemic heart disease in a Mediterranean population

Homocysteine (Hcy) is recognised as a risk factor for IHD. Serum Hcy is negatively correlated with serum folate levels, the main sources of which are fruits, vegetables and legumes. The present case-control study was designed to examine the relationship between serum Hcy levels and IHD and to assess the role of dietary factors in the southern Mediterranean population of Crete, Greece. Serum Hcy, folate, vitamin B12, creatinine and glucose levels and a full lipid profile were measured in 152 patients with established IHD, median age 64 (range 33-77) years, and 152 healthy control subjects, age- and sex-matched. Dietary data were assessed using a 3 d food intake record. Compared with controls, patients with IHD had significantly higher daily intakes of vitamin B12 and MUFA and significantly lower intakes of carbohydrate, fibre, folate, cholesterol, n-3 fatty acids and total trans unsaturated fatty acids. Moreover, patients had significantly higher serum Hcy, vitamin B12 and creatinine levels, but significantly lower folate. Serum folate concentrations in both groups had a significant positive correlation with dietary fibre consumption and a significant inverse correlation with vitamin B12 intake. IHD patients should be encouraged to increase their daily dietary intake of fibre, folate and n-3 fatty acids, which are significant components of the traditional Cretan Mediterranean diet. Where dietary folate intake is inadequate, folate supplements are recommended to reduce elevated Hcy levels.     

Fruit and vegetable consumption is lower and saturated fat intake is higher among Canadians reporting smoking.

Understanding differences in dietary patterns by smoking status is important for nutritionists and health educators involved in helping individuals to make healthy dietary and lifestyle choices. Although smokers have a poor quality diet compared with nonsmokers, no study has examined nutritional adequacy and variability in the nutrient intake of smokers. The aim of this study was to compare dietary habits of smokers with nonsmokers in terms of nutrient intake, food groups contributing to nutrient intake, nutritional adequacy and day-to-day variation in nutrient intake. Noninstitutionalized adults aged 18--65 y (n = 1543) who participated in the Food Habits of Canadians Survey (1997--1998) were studied. Subjects, selected from across Canada using a multistage, random-sampling strategy, completed an in-home 24-h dietary recall. Repeat interviews were conducted in a subsample to estimate variability in nutrient intake. Smokers had higher intakes of total and saturated fat, and lower intakes of folate, vitamin C and fiber than nonsmokers. There were no significant differences in calcium, zinc and vitamin A intakes or day-to-day variation in nutrient intake by smoking status. Smokers consumed significantly fewer fruits and vegetables than nonsmokers, leading to lower intakes of folate and vitamin C. In conclusion, smokers have a less healthy diet than nonsmokers, placing them at higher risk for chronic disease as a result of both dietary and smoking habits. Diet may act as a confounder in smoking-disease relationships.     

Zinc status of healthy elderly adults: response to supplementation

The zinc status of 53 healthy elderly subjects was evaluated. The dietary Zn intake estimated by 24-h recall was 9.2 mg/d and 65% of subjects had intakes less than two-thirds of the RDA. Mean serum Zn concentration (13.0 mumol/L) and urinary Zn excretion (7.0 mumol/d) were normal. The Zn content of platelets, mononuclear cells, and polymorphonuclear cells was 5.8, 147, and 135 nmol/10(9) cells, respectively. Seventeen subjects were supplemented for 28 d with 30 mg Zn/d. The mean concentration of Zn in serum and urine increased 24% and 2.5-fold, respectively. Zn content of platelets and leukocytes did not change with Zn supplementation. The concentration of visceral proteins (ie, albumin, prealbumin, transferrin, and retinol-binding protein) and immunoglobulins (ie, IgG, IgA, and IgM) did not change with Zn supplementation. The data indicate that aging per se does not necessarily imply poor Zn status.     

Seasonal variation of food consumption and selected nutrient intake in Linxian,a high risk area for esophageal cancer in China

Linxian, China, is a region with high incidence of esophageal cancer and a history of poor nutritional status. Nutrition Intervention Trials were conducted in this area from 1985 through 1991 and found a reduction in total cancer mortality in the group receiving supplementation of beta-carotene/selenium/alpha-tocopherol. The positive results of those trials have, in part, been ascribed to the poor nutritional status of this population. To investigate more recent food patterns, nutrient intakes, and seasonal variations in the diet, dietary surveys were conducted among the residents of Linxian in 1996. Food consumption data were collected among 104 households in spring and 106 households in autumn using a method of food inventory changes. Intake of nutrients was estimated and compared to the Chinese Recommended Dietary Allowance (RDA). In both seasons, the five most common food groups consumed were cereals, fresh vegetables, yams, seasoning, and eggs. Low nutrient intakes were found for selenium (79% RDA and 66% RDA), zinc (72% RDA and 62% RDA), vitamin B2 (64% RDA and 52% RDA), and calcium (53% RDA and 39% RDA) in both spring and autumn. A large seasonal variation was seen in the consumption of leafy vegetables, root vegetables and eggs, all of which might have contributed to the lower intake of vitamin A (25% RDA), vitamin C (75% RDA), protein (76% RDA), and vitamin E (78% RDA) in autumn. These indicate that the nutrient intake in Linxian is inadequate for a number of vitamins and minerals including those shown to be associated with esophageal cancer.