Fortification masks nutrient dilution due to added sugars in the diet of children and adolescents

High intakes of added sugars have often been suspected of lowering nutrient density, especially in the diet of children and adolescents. Because fortified foods, which currently contribute considerably to the intake of vitamins and minerals, are often also sweetened with added sugars, they could counteract this nutrient dilution. Data from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD)-Study were used to assess the effects of added sugars, fortified food and energy intakes, time and age on nutrient densities. A total of 4993 3-d weighed dietary records from 849 children and adolescents 2-18 y old, collected between 1985 and 2001 were analyzed using a mixed linear model, in which the means of the data and the covariance structure specific to the DONALD-Study was modeled. In general, nutrient densities in the diets of children and adolescents were above recommended nutrient densities. Added sugars intake [in percentage of energy intake (E%)] was positively associated with energy intake (MJ/d; P < 0.05) and intake of fortified food (E%; P < 0.0001). Positive effects of fortification on nutrient densities (usually P < 0.0001) exceeded the negative effects of added sugars intake (usually P < 0.01) for most nutrients, in some cases even twofold. Associations between energy intake and nutrient densities were negative and, with the exception of thiamin in 2- to 3-y-olds, statistically significant. Time and age trends were heterogeneous. Our data did not show significant nutrient dilution because of added sugars. The positive effect of fortification on nutrient densities was greater than the negative effect of added sugars. Therefore, fortification should more often be considered in dietary analyses.     

Public health aspects of food fortification: a question of balance

Micronutrient malnutrition is widespread throughout the world, with important health and economic consequences. Tools to address this situation include food fortification, supplementation and dietary diversification, each having different and complementary roles. Fortification (mandatory and voluntary) has been practised over several decades in Western countries as well as in developing countries. Iodised salt was introduced in the USA in 1924 to reduce severe I deficiency. In 1938 voluntary enrichment of flours and breads with niacin and Fe was initiated to reduce the incidence of pellagra and Fe-deficiency anaemia respectively. Micronutrient intakes in European countries appear to be generally adequate for most nutrients. However, a number of population subgroups are at higher risk of suboptimal intakes (below the lower reference nutrient intake) for some micronutrients, e.g. folate, Fe, Zn and Ca in children, adolescents and young women. Dietary surveys indicate that fortified foods play a role in mitigating such risks for several important nutrients. The number of foods suited to fortification are considerably limited by several factors, including technological properties (notably moisture, pH and O2 permeability), leading to unacceptable taste and appearance, as well as cost and consumer expectations. In countries in which voluntary fortification is widely practised micronutrient intakes are considerably below tolerable upper intake levels. Concerns about safety are addressed in relation to the potentially increased level or proportion of fortified foods (e.g. following potential EU legislation), for nutrients with relatively low tolerable upper intake levels and where the potential benefit and risks are in different subpopulations (e.g. folic acid). Recent models for assessing these issues are discussed.     

Longitudinal assessment of micronutrient intake among African-American and white girls: The National Heart, Lung, and Blood Institute Growth and Health Study

OBJECTIVE: Low intakes of micronutrients among adolescents may be linked to long-term health risks, especially in African-American girls. This report describes intake of key micronutrients relative to the Dietary Reference Intakes in a sample of African-American and white girls. DESIGN: Longitudinal analyses used data from 3-day food records collected in the National Heart, Lung, and Blood Institute Growth and Health Study. SUBJECTS/SETTING: Subjects included 1,166 white and 1,213 African-American girls (aged 9 to 18 years). MAIN OUTCOME MEASURES: Estimated usual daily intakes of vitamins A, E, C, D, B-6, B-12, magnesium, folate, calcium, and zinc were compared to the Adequate Intake (for vitamin D and calcium) or the Estimated Average Requirement (EAR) (all other micronutrients). STATISTICAL ANALYSES PERFORMED: Usual daily intake of each micronutrient was estimated. For nutrients with an EAR, the EAR cut-point method was used to assess the prevalence of low nutrient intakes. Mixed models were used to identify age and racial differences in usual daily intake of each nutrient. RESULTS: African-American girls consumed less vitamin A and D, calcium, and magnesium compared to white girls. Regardless of race, a substantial percentage of girls had intakes below the EAR: vitamin E (81.2% to 99.0%), magnesium (24.0% to 94.5%), folate (46.0% to 87.3%). Intakes of vitamins A, D, and C; calcium; and magnesium decreased across years. As girls aged, there was an increasing proportion with intakes below the EAR for vitamins A, C, B-6, and B-12. CONCLUSIONS: Food and nutrition professionals should continue to educate adolescent girls, especially those who are African American, about the importance of a nutrient-dense diet for optimum health.     

Examination of vitamin intakes among US adults by dietary supplement use

BackgroundMore than half of US adults use dietary supplements. Some reports suggest that supplement users have higher vitamin intakes from foods than nonusers, but this observation has not been examined using nationally representative survey data.ObjectiveThe purpose of this analysis was to examine vitamin intakes from foods by supplement use and how dietary supplements contribute to meeting or exceeding the Dietary Reference Intakes for selected vitamins using data from the National Health and Nutrition Examination Survey among adults (aged ≥19 years) in 2003-2006 (n=8,860).ResultsAmong male users, mean intakes of folate and vitamins A, E, and K from food sources were significantly higher than among nonusers. Among women, mean intakes of folate and vitamins A, C, D, and E from foods were higher among users than nonusers. Total intakes (food and supplements) were higher for every vitamin we examined among users than the dietary vitamin intakes of nonusers. Supplement use helped lower the prevalence of intakes below the Estimated Average Requirement for every vitamin we examined, but for folic acid and vitamins A, B-6, and C, supplement use increased the likelihood of intakes above the Tolerable Upper Intake Level.ConclusionsSupplement use was associated with higher mean intakes of some vitamins from foods among users than nonusers, but it was not associated with the prevalence of intakes less than the Estimated Average Requirement from foods. Those who do not use vitamin supplements had significantly higher prevalence of inadequate vitamin intakes; however, the use of supplements can contribute to excess intake for some vitamins.     

Children and adolescents' choices of foods and beverages high in added sugars are associated with intakes of key nutrients and food groups.

PURPOSE: To determine associations between intakes of the primary food and beverage sources of added sugars and intakes of key nutrients and food pyramid groups among U.S. children aged 6-17 years. METHODS: The 1994-96 and 1998 U.S. Department of Agriculture (USDA) Continuing Survey of Food Intakes by Individuals (CSFII) were used to examine the diets of U.S. children aged 6-17 years, who provided 2 full days of dietary data. The nationally representative sample (n = 3038) included children age 6-11 (n = 1913) and adolescents age 12-17 (n = 1125). Food codes for sweetened foods and beverages were selected from the USDA Food Coding Scheme and categorized into five food and beverage categories. The Statistical Analysis System software program was used to recode and format the data for statistical analysis and the Survey Data Analysis System was used to apply sample weights and generate statistical procedures. RESULTS: The consumption of sweetened dairy products was positively associated with calcium intakes for children and adolescents. Consumption of presweetened cereals increased the likelihood of the children and adolescents meeting recommendations for the essential shortfall micronutrients calcium, folate, and iron, whereas the consumption of sugar-sweetened beverages, sugars and sweets, and sweetened grains decreased the likelihood of meeting the Dietary Reference Intakes (DRI) for these nutrients. Only children who were nonconsumers of sugar-sweetened beverages had a mean calcium intake that met the adequate intakes (AI). Consumption of sweetened dairy products and presweetened cereals was positively associated with the number of dairy servings consumed per day for both age groups. CONCLUSIONS: On average, consumption of sweetened dairy foods and beverages and presweetened cereals had a positive impact on children and adolescents' diet quality, whereas sugar-sweetened beverages, sugars and sweets, and sweetened grains had a negative impact on their diet quality.     

Changes in Dietary Guidance: Implications for Food and Nutrient Databases

Two types of dietary guidance for Americans have recently been released, and both have important implications for the way data are organized on food and nutrient databases. New dietary reference intakes (DRIs) have been set for 17 nutrients, and in several cases the units for these recommendations do not match those traditionally carried on nutrient databases. Furthermore, some of the tolerable upper intake levels (ULs) are specified only for supplemental and fortification forms of nutrients, which necessitates calculating separate intake values for nutrients from foods and nutrients that are added to foods or taken as supplements. The year 2000 revision of the Dietary Guidelines for Americans also suggest new ways to evaluate dietary intakes: there is an increased emphasis on obtaining an appropriate number of servings from food groups such as fruits, vegetables, whole grains, and lowfat dairy products. To allow users of nutrient databases to provide relevant evaluations of dietary data, developers will need to consider carrying a much larger array of variables in order to calculate intakes of folate in folate equivalents, vitamin E as alpha-tocopherol (not as alpha-tocopherol equivalents), nutrients occurring in foods versus added or supplemental nutrients, and the number of servings from a variety of food groups.

• •For more information on the DRIs, see:.
• •For more information on the year 2000 Dietary Guidelines, see:

     

The contribution of enrichment and fortification to nutrient intake of women

A volunteer group of 162 women aged 25 to 49 years was recruited from three suburban supermarkets in central New York state. The women completed 3-day food records, which were analyzed for total nutrient intake and contribution of eight nutrients from three sources: (a) nutrients naturally present in food, (b) enriched/fortified foods with a standard of identity (FF + SI), and (c) fortified foods without standards of identity (FF-SI). Subjects were placed into study groups of high-, moderate-, and low-fortifiers on the basis of frequency of intake of highly fortified foods (FF-SI) which, unlike FF + SI, are not staple foods and may represent selective dietary nutrient addition by the consumer. For all groups, mean intakes of riboflavin, niacin, and vitamins A and C were greater than 100% of the RDAs without nutrient addition. Mean thiamin intake met the RDA only when the nutrient addition from FF + SI was included. Mean intakes of iron, calcium, and vitamin D were all below the RDA even when all sources of intake were included. No significant differences between study groups were found for total nutrient intake. With the exceptions of vitamin C, vitamin D, and calcium, high- and moderate-fortifiers had significantly greater (p less than .01) nutrient intake from fortification. Low-fortifiers had significantly greater (p less than .05) intake from naturally occurring vitamins A and C than high-fortifiers.     

Ten-year trends in vitamin and mineral intake from fortified food in German children and adolescents

OBJECTIVE: We investigated time trends in consumption patterns, and energy and nutrient intakes (protein, fat, carbohydrates, added sugars, vitamins A, E, C, B1, B2 and B6, niacin, folate, calcium and iron) from fortified food in children and adolescents between 1987 and 1996 in Germany. DESIGN: Mixed longitudinal survey (DONALD study) with 3 d weighed dietary records (n=2062 from 594 subjects), one subject per family per year chosen by random. SETTING: Dortmund (Western Germany) district cohort. SUBJECTS: 285 males, 309 females; mean age 6 y (2-13 y). RESULTS: Almost all children and adolescents consumed fortified food irrespective of the year studied. With the exception of vitamin E, significant time trends in the proportions of nutrient intakes from fortification were observed. The fortification of food with vitamins A, C, B1, B2 and B6 and niacin raised the already adequate intakes from non-fortified food (100% to 150% of reference intake values) by 20-50%. The fortification of food with vitamin E and folate raised the low intakes from non-fortified food (about 50% of reference intake values) to about 80% (folate) and 100% (vitamin E) of the references. Fortification of food with calcium and iron was not significant (<10%), but while total intake of calcium was adequate, total intake of iron remained critical. CONCLUSIONS: Since the nutrient intake of the population of children and adolescents studied is adequate with respect to vitamins A, C, B1, B2 and B6, niacin and calcium, fortification seems inefficient, while fortification of food with vitamin E and folate, but not iron, improves an inadequate intake. SPONSORSHIP: The DONALD study is supported by the German Federal Ministry of Health and the North-Rhine-Westphalian Ministry of Science and Research. European Journal of Clinical Nutrition (2000) 54, 81-86     

Approaches to Intervention Among Children and Adolescents

An analysis of current dietary intakes of preschool and school children and adolescents belonging to poor income groups in India indicate that they suffer from deficiencies of several nutrients with associated clinical and functional consequences. The observed deficiencies include energy, calcium, iron, zinc, vitamin A, riboflavin, ascorbic acid, and folate. Some degree of protein deficiency is also present. The best strategy to correct the deficiencies of these nutrients is the food-based approach where nutrient-rich food supplements are formulated with nutrient-rich familiar foods and given to children at the household level. Another strategy for helping mothers and preschool children to achieve the recommended daily intakes is to fortify with micronutrients the supplementary foods currently targeted to them for improving their energy and protein intake. This can be achieved by expanding the current supplementary feeding program to school children and adolescents.     

Consumption of 'extra' foods by Australian children: types, quantities and contribution to energy and nutrient intakes

OBJECTIVE: To measure the types and quantities of energy-dense, nutrient-poor 'extra' foods consumed by Australian children and adolescents and their contribution to total energy and nutrient intakes. DESIGN, SETTING AND SUBJECTS: We used data from 3007 children, aged 2-18 years, who participated in the nationally representative 1995 National Nutrition Survey. Intake was determined by 24-h recall and 'extra' foods were defined using principles outlined in the Australian Guide to Healthy Eating (AGHE) and by applying cut points for maximum amounts of fat and sugar within each food category. RESULTS: All children (99.8%) consumed at least one 'extra' food and the most commonly consumed were margarine, sugar-sweetened soft drinks, cordials and sugar. 'Extra' foods contributed 41% of daily energy intake. Those foods contributing most to energy intake were fried potatoes (4.2%), sugar-sweetened soft drinks (3.3%), ice cream/ice confection (3.1%) and cordials (2.7%). Age and sex were important determinants of 'extra' food intake, with males and older children generally consuming more and different types of, 'extra' foods than females and younger children. 'Extra' foods contributed 19% protein, 47% total fat, 47% saturated fat, 54% sugar, and approximately 20-25% of selected micronutrients to the diet. Calcium and zinc intakes from core foods were below 70% of the recommended dietary intakes for adolescent girls. CONCLUSIONS: 'Extra' foods are over-consumed at two to four times the recommended limits and contribute excessively to the energy, fat and sugar intakes of Australian children, while providing relatively few micronutrients. This is of concern in terms of children's weight and nutrient status.     

Nutrient intakes of adolescents with phenylketonuria and infants and children with maple syrup urine disease on semisynthetic diets.

Adequacy of nutrient intakes of adolescents with and without phenylketonuria (PKU) and infants and children with and without maple syrup urine disease (MSUD) were assessed using 3-day diet records sorted by disease and by age of the subject. Mean intakes of all nutrients were greater than two-thirds of the Recommended Dietary Allowances (RDA) or Estimated Safe and Adequate Daily Dietary Intakes (ESADDI) for all adolescents studied, with the exception of selenium (Se) in PKU adolescents, which averaged 27.8 micrograms. For adolescents with PKU, > 50% of the RDA or ESADDI for all nutrients was provided by elemental or modified protein hydrolysate medical foods, except for vitamin A in children aged 11-15 years and Se in children 11-18 years. Mean nutrient intakes of all infants and children were greater than two-thirds of the RDA or ESADDI for all nutrients except Se in MSUD children aged 1-11 years, where intakes ranged from 6.4 to 13.2 micrograms (21-66% of the RDA). The medical foods provided for most of the RDA and ESADDI recommendations, with the exception of Se in MSUD children.     

Within- and Between-Individual Variation in Nutrient Intake in Children and Adolescents

BackgroundLittle is known regarding the number of 24-hour recalls required to rank-order children and adolescents on usual intake for diet–disease studies.ObjectiveTo determine the within- to between-individual variance ratios and number of 24-hour recalls required to rank-order individuals on usual intake for select macro- and micronutrients in a large, multiracial/ethnic sample of children and adolescents.DesignCross-sectional survey.Participants/settingChildren and adolescents ages 6 to 17 years participating in the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey (NHANES).Main outcome measuresVariance ratios for predefined sex, age (children age 6 to 11 years, adolescents age 12 to 17 years), and racial/ethnic groups (Mexican American/Hispanic, non-Hispanic black, and non-Hispanic white).Statistical analysisMixed-effects linear regression models were used to estimate within- and between-individual variance components for selected nutrients. The number of 24-hour recalls required to rank-order participants on usual intake (absolute values and energy-adjusted) was obtained from the nutrient variance ratios for various levels of accuracy.ResultsVariance ratios were more than 1 for all nutrients examined. High values (variance ratio >3) were observed for protein, saturated and unsaturated fatty acids, cholesterol, and several micronutrients. Variance ratios for absolute nutrient intakes were similar for both sexes within age groups, but higher for children than for adolescents. A total of six to nine and three to six 24-hour recalls were typically sufficient to rank-order children and adolescents, respectively, on usual intake with an accuracy of r=0.8. Additional recalls were required to achieve the same accuracy for energy-adjusted nutrients. Variance ratios were similar for adolescents across racial/ethnic groups, but highly variable in children.ConclusionsA total of six to nine 24-hour recalls may represent a reasonable trade-off between accuracy and participant burden for rank-ordering nutrient intakes in children and adolescents. Additional research is required to determine whether this may be reduced using statistical modeling–based approaches and the number of recalls children and adolescents will reliably complete.     

Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey

OBJECTIVE: To examine the adequacy of dietary intake of calcium; folate; and vitamins C, D, E, B-6, and B-12 in premenopausal US women of differing ethnicity. DESIGN: Analyses of single and duplicate 24-hour recalls were conducted to determine dietary intake during the Third National Health and Nutrition Examination Survey. SUBJECTS: Three thousand five hundred eighty-five randomly selected women aged 20 to 50 years from across the United States who were not pregnant or lactating were examined between 1988 and 1994. STATISTICAL ANALYSES: Usual nutrient intake distributions were estimated using the Iowa State University method for adjustment of the distribution. The Estimated Average Requirement cut-point method was used to determine the proportion of women with inadequate intake for each nutrient in each ethnic group. RESULTS: More than 75% of women irrespective of ethnic group had usual intakes of calcium lower than the new Adequate Intake. More than 90% of the women had inadequate intakes of folate and vitamin E from food sources alone. More than half of smokers had inadequate intakes of vitamin C. Intakes of vitamins B-6 and B-12 were low in less than 10% of these women. APPLICATIONS/CONCLUSIONS: This article provides evidence that a high proportion of premenopausal US women are underconsuming a variety of nutrients. Dietary intakes alone are not currently adequate to meet the new recommended intakes. Nutritional supplement use is widespread and effective, but does not eliminate the concerns for at-risk populations. Awareness of the general inadequacies in intakes of vitamin E and folic acid at large, and in many women vitamin C as well, can help direct individual dietary recommendations and place the emphasis in group counseling on nutrients that are of widespread concern. In addition, foods rich in vitamins B-6 and of general nutritional benefit should be emphasized among African American women in the United States as a substantial proportion of this group is still showing inadequate intakes from foods.     

Fortification contributed greatly to vitamin and mineral intakes in the United States, 1989-1991

The objective of this work was to quantify the contribution of fortification (defined here as adding nutrients beyond traditional enrichment standards) to dietary nutrient intakes in the United States. A list of fortified foods was developed that was relevant at the time of the analyses, and prefortification (naturally occurring) nutrients in the fortified foods were determined from industry-supplied data. Using dietary data from the 1989-1991 Continuing Survey of Food Intakes by Individuals (CSFII), intakes of nine nutrients were determined both as reported in the CSFII (i.e., postfortification) and also by using prefortification nutrient levels for the identified fortified foods. We report data for the total population age >/= 1 y based on respondents (n = 11,710) with 3 d of dietary data, as well as select age/gender subgroups. All data were weighted. Fortification substantially increased the intakes of all nutrients examined except calcium, in all age/gender groups but especially in children. In numerous cases, fortification was responsible for boosting median or 25th percentile intakes from below to above the RDA. The breakfast cereal category was responsible for nearly all the intake of nutrients from fortified foods, except vitamin C for which juice-type beverages made as great or a greater contribution. These data from 1989 to 1991 serve as a useful baseline with which to compare contributions of fortification as the practice expands. The large contribution of fortification even in 1989-1991 suggests that continued monitoring of fortification practices, using methods such as those presented here, is important.     

Using dietary reference intake-based methods to estimate prevalence of inadequate nutrient intake among female students in Brazil

The objective of this study was to estimate the prevalence of inadequate usual nutrient intake among female university students. This was a cross-sectional study in which 119 students at a public university in the State of S?o Paulo, Brazil, completed 3-day estimated food records. These were analyzed for nutrient content, and intake distributions were determined. Nutrient intake distributions were estimated using the National Research Council method. For nutrients for which an Estimated Average Requirement has been established, the Estimated Average Requirement cutpoint method was used to determine the proportion of students with inadequate intake. The students' food records indicated inadequate intakes of folate (99%), zinc (47%), and copper (33%). For approximately 95% of the students in this study, calcium was less than the Adequate Intake. The results showed the need for improvement in dietary choices to minimize the prevalence of inadequate intake of folate, zinc, copper, and calcium in this group.     

Limitations and resolutions for dietary assessment of micronutrient intakes

Micronutrients (vitamins and minerals) are present mostly in small amounts, or concentrated in certain foods. Traditional Asian diets are very diverse and consist largely of foods of plant sources, including several herbs and spices. Challenges in assessing dietary intake include difficulties in collecting information on ingredients in dishes as well as in meals shared by family members, and cooking effects. Variations in intakes of micronutrients are determined by frequency of consumption, and how common or concentrated the nutrients are in specific foods. Moreover, assessing only nutrient intake is inadequate, since other food components affect its bioavailability. Non-nutrient food constituents, such as, phytate and polyphenols interfere with the bioavailability of iron and zinc. Bioconversion and bioefficacy of precursor nutrients, such as, carotenoids, also affect the estimated intake of vitamin A in its active form. Different strategies are required to deal with these challenges in assessing dietary intakes of micronutrients in order to establish the prevalence of inadequate intake, as well as the association between intake and nutritional status.     

Foods, nutrients and portions consumed by a sample of Australian children aged 16–24 months

Aim:  To describe the diet of a sample of Australian children aged 16–24 months with regard to the amounts of foods and nutrients consumed.
Methods:  Cross-sectional data collected from participants in a five-year randomised trial of the primary prevention of asthma. Pregnant women with a family history of atopy were recruited from six hospital antenatal clinics in western Sydney. At the 18-month assessment, carers of 429 of children completed three-day weighed food records. Three-day average intakes of foods and nutrients and average portions per eating occasion for commonly consumed foods. T -tests for comparing gender differences.
Results:  Diets were characterised by large amounts of milk and non-milk drinks with smaller amounts of cereals, fruits, vegetables and meats. Total energy intake was significantly higher for boys than girls and exceeded estimated energy requirements in both boys and girls. Food groups contributing most to energy included milk and milk products (35%), cereals (15%), cereal-based products (9%) and non-milk drinks (8%). Micronutrient intakes were below the Estimated Average Requirement in more than 5% of the children for vitamin A, calcium, vitamin C and iron. Sodium intakes exceeded the upper level of 1000 mg for 62% of children, while dietary fibre intake was only half the Adequate Intake of 14 g. Relatively few foods were widely consumed and median portion sizes were typically small in relation to commonly used reference portion sizes.
Conclusion:  These data may be useful as a preliminary basis for developing age-specific dietary surveillance tools and dietary guidance for children aged one to two years.     

Is "processed" a four-letter word? The role of processed foods in achieving dietary guidelines and nutrient recommendations

This paper, based on the symposium "Is 'Processed' a Four-Letter Word? The Role of Processed Foods in Achieving Dietary Guidelines and Nutrient Recommendations in the U.S." describes ongoing efforts and challenges at the nutrition-food science interface and public health; addresses misinformation about processed foods by showing that processed fruits and vegetables made important dietary contributions (e.g., fiber, folate, potassium, vitamins A and C) to nutrient intake among NHANES 2003-2006 participants, that major sources of vitamins (except vitamin K) were provided by enrichment and fortification and that enrichment and fortification helped decrease the percentage of the population below the Estimated Average Requirement for vitamin A, thiamin, folate, and iron; describes how negative consumer perceptions and consumer confusion about processed foods led to the development of science-based information on food processing and technology that aligns with health objectives; and examines challenges and opportunities faced by food scientists who must balance consumer preferences, federal regulations, and issues surrounding food safety, cost, unintended consequences, and sustainability when developing healthful foods that align with dietary guidelines.     

Trends in Vitamin C Consumption in the United States: 1999–2018

Low intakes of fruits and vegetables have resulted in suboptimal intakes of several micronutrients, including vitamin C. This cross-sectional study used data from 84,902 children/adults (≥1 y) who completed a 24-h dietary recall as part of the United States National Health and Nutrition Examination Survey (1999–2018). Mean vitamin C intakes from foods/beverages were calculated as were trends in major food/beverage sources of vitamin C. Percentages below the Estimated Average Requirement (EAR) were estimated. Overall, mean vitamin C consumption declined by 23% (97–75 mg/d; p-value for trend < 0.001). 100% fruit juice was the leading source of vitamin C (25.6% of total or 21.7mg/d), but this declined by 48% (25–13 mg/d; p-value for trend < 0.001). Whole fruit increased among children/adolescents (+75.8%;10–17 mg/d; p-value for trend < 0.001), but not adults, while the vegetable contribution was generally unchanged. The proportion of the population below the EAR increased by 23.8% on a relative scale or 9 percentage points on an absolute scale (38.3–47.4%). Declines in vitamin C intake is driven largely by decreases in fruit juice coupled with modest increases in whole fruit. Due to associations between vitamin C intake and numerous health outcomes these trends warrant careful monitoring moving forward.     

Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0–24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021

(1) Background: Breastmilk provides all the nutrition an infant requires between 0–6 months. After that, complementary foods are needed to meet the child’s increasing energy and nutrient requirements. Inadequate energy and nutrient intake may lead to growth faltering, impaired neurodevelopment, and increased disease risk. While the importance of early life nutrition is well recognized, there are few investigations assessing the nutritional adequacy of Australian children <24 months. Here, we describe usual energy and nutrient intake distributions, including the prevalence of inadequate intakes and exceeding the upper limit (UL), in a national sample of Australian children 6– 24 months and infants < six months who had commenced solids and/or formula. (2) Methods: Dietary intakes were assessed using a one-day food record for 976 children with a repeat one-day record in a random subset. (3) Results: Based on the Nutrient Reference Values for Australia and New Zealand, children’s intakes were above the Adequate Intake or Estimated Average Requirement for most nutrients. Exceptions were iron and zinc where the prevalence of inadequacy was estimated to be 75% and 20%, respectively, for infants aged 6–11.9 months. Low iron intake was also observed in one quarter of toddlers 12–24 months. On average, children consumed 10% more energy than predicted based on Estimated Energy Requirements, and ~10% were classified as overweight based on their weight for length. One third of toddlers exceeded the tolerable upper limit for sodium and consumed > 1000 mg/day. Of the children under six months, 18% and 43% exceeded the UL for vitamin A (retinol) and zinc. (4) Conclusions: Compared to nutrient reference values, diets were sufficient for most nutrients; however, iron was a limiting nutrient for infants aged 6–11.9 months and toddlers 12–24 months potentially putting them at risk for iron deficiency. Excessive sodium intake among toddlers is a concern as this may increase the risk for hypertension.