Associations between concentrations of uric acid with concentrations of vitamin A and beta-carotene among adults in the United States

Our objective was to examine the cross-sectional associations between concentrations of vitamin A and beta-carotene, a major source of vitamin A, with concentrations of uric acid in a nationally representative sample of adults from the United States. We conducted a cross-sectional study using data from up to 10893 participants aged ≥20 years of National Health and Nutrition Examination Survey from 2001 to 2006. Concentrations of uric acid adjusted for numerous covariates increased from 305.8 μmol/L in the lowest quintile of vitamin A to 335.3 μmol/L in the highest quintile (p for linear trend <0.001). The prevalence ratio for hyperuricemia also increased progressively across quintiles of serum vitamin A reaching 1.82 (95% confidence interval [CI]: 1.52, 2.16; p for linear trend <0.001) in the top quintile in the maximally adjusted model. Adjusted mean concentrations of uric acid decreased progressively from quintile 1 (333.8 μmol/L) through quintile 4 of concentrations of beta-carotene and were similar for quintiles 4 (313.5 μmol/L) and 5 (313.8 μmol/L). Concentrations of beta-carotene were inversely associated with hyperuricemia (adjusted prevalence ratio comparing highest with lowest quintile = 0.61; 95% CI: 0.52, 0.72; p for linear trend <0.001). Concentrations of uric acid were significantly and positively associated with concentrations of vitamin A and inversely with concentrations of beta-carotene. These cross-sectional findings require confirmation with experimental studies of vitamin A and beta-carotene supplementation.     

Nutrients from dairy foods are difficult to replace in diets of Americans: food pattern modeling and an analyses of the National Health and Nutrition Examination Survey 2003-2006

Because dairy products provide shortfall nutrients (eg, calcium, potassium, and vitamin D) and other important nutrients, this study hypothesized that it would be difficult for Americans to meet nutritional requirements for these nutrients in the absence of dairy product consumption or when recommended nondairy calcium sources are consumed. To test this hypothesis, MyPyramid dietary pattern modeling exercises and an analyses of data from the National Health and Nutrition Examination Survey 2003-2006 were conducted in those aged at least 2 years (n = 16 822). Impact of adding or removing 1 serving of dairy, removing all dairy, and replacing dairy with nondairy calcium sources was evaluated. Dietary pattern modeling indicated that at least 3 servings of dairy foods are needed to help individuals meet recommendations for nutrients, such as calcium and magnesium, and 4 servings may be needed to help some groups meet potassium recommendations. A calcium-equivalent serving of dairy requires 1.1 servings of fortified soy beverage, 0.6 serving of fortified orange juice, 1.2 servings of bony fish, or 2.2 servings of leafy greens. The replacement of dairy with calcium-equivalent foods alters the overall nutritional profile of the diet and affects nutrients including protein, potassium, magnesium, phosphorus, riboflavin, vitamins A, D and B₁₂. Similar modeling exercises using consumption data from the National Health and Nutrition Examination Survey also demonstrated that nondairy calcium replacement foods are not a nutritionally equivalent substitute for dairy products. In conclusion, although it is possible to meet calcium intake recommendations without consuming dairy foods, calcium replacement foods are not a nutritionally equivalent substitute for dairy foods and consumption of a calcium-equivalent amount of some nondairy foods is unrealistic.     

Healthy lifestyle behaviors and all-cause mortality among adults in the United States

Objective

To examine the links between three fundamental healthy lifestyle behaviors (not smoking, healthy diet, and adequate physical activity) and all-cause mortality in a national sample of adults in the United States.

Method

We used data from 8375 U.S. participants aged ≥ 20 years of the National Health and Nutrition Examination Survey 1999-2002 who were followed through 2006.

Results

During a mean follow-up of 5.7 years, 745 deaths occurred. Compared with their counterparts, the risk for all-cause mortality was reduced by 56% (95% confidence interval [CI]: 35%-70%) among adults who were nonsmokers, 47% (95% CI: 36%, 57%) among adults who were physically active, and 26% (95% CI: 4%, 42%) among adults who consumed a healthy diet. Compared with participants who had no healthy behaviors, the risk decreased progressively as the number of healthy behaviors increased. Adjusted hazard ratios and 95% confidence interval were 0.60 (0.38, 0.95), 0.45 (0.30, 0.67), and 0.18 (0.11, 0.29) for 1, 2, and 3 healthy behaviors, respectively.

Conclusion

Adults who do not smoke, consume a healthy diet, and engage in sufficient physical activity can substantially reduce their risk for early death.     

Knowledge,perceptions, and behaviors of adults concerning nonalcoholic beverages suggest some lack of comprehension related to sugars

Key recommendations in the 2010 Dietary Guidelines for Americans and US Department of Agriculture's MyPlate are to reduce the intake of added sugars, particularly from sugar-sweetened beverages, and drink water instead of “sugary” beverages. However, little is known about consumer knowledge, perceptions, and behaviors regarding sugars in beverages. We hypothesized that consumers would have limited or inaccurate knowledge of the sugars in beverages and that their beverage consumption behaviors would not reflect their primary concerns related to sugars in beverages. An online survey was completed by 3361 adults 18 years and older residing throughout the United States. Water was consumed in the highest amounts followed by (in descending amounts) other beverages (includes coffee and tea), added sugar beverages, milk, diet drinks, and 100% fruit juice and blends. Participants primarily associated the term “sugary” with beverages containing added sugars; however, almost 40% identified 100% fruit juice as sugary. Some participants misidentified the types of sugars in beverages, particularly with respect to milk and 100% fruit juices. Generally, beverage choices were consistent with stated concerns about total, added, or natural sugars; however, less than 40% of participants identified added sugars as a primary concern when choosing beverages despite public health recommendations to reduce the intake of added sugars and sugar-sweetened beverages. Results suggest that there may be a considerable level of consumer misunderstanding or confusion about the types of sugars in beverages. More consumer research and education are needed with the goal of helping consumers make more informed and healthy beverage choices.     

Evaluation of the Food And Nutrient Database for Dietary Studies for use with a mobile telephone food record

The development of a mobile telephone food record (mpFR) in which image analysis and volume estimation data can be indexed with the Food and Nutrient Database for Dietary Studies (FNDDS) has the potential to improve the accuracy of dietary assessment. To validate the mpFR for use with adolescents, a convenience sample of adolescents, aged 11–18 years, was recruited to eat all meals and snacks in a controlled feeding environment over a 24-h period. Each food item matched a food code in the FNDDS 3.0. The objective of this analysis was to compare the measured energy and protein content of foods to the published values in the FNDDS. Duplicate plates of all meals and snacks were prepared, and samples of 20 foods were individually weighed, homogenized, freeze dried, and analyzed for energy with a bomb calorimeter and for protein with a Dumas nitrogen analyzer. Eleven of the twenty food items had energy values in the FNDDS within ±10% of the measured energy value. The measured energy and protein values from all foods correlated significantly with the energy (r = 0.981, P < 0.01) and protein (r = 0.911, P < 0.01) values in the FNDDS. These results support the use of the FNDDS with the mpFR.     

Total dietary fiber intakes in the US population are related to whole grain consumption: results from the National Health and Nutrition Examination Survey 2009 to 2010

Whole grain (WG) foods have been shown to reduce chronic disease risk and overweight. Total dietary fiber is associated with WG and its health benefits. The purpose was to determine whether associations exist between WG intake (no-WG intake, 0 ounce equivalent [oz eq]; low, >0-<3 oz eq; high, ≥3 oz eq) and total dietary fiber intake among Americans 2 years and older. One-day food intake data from the US National Health and Nutrition Examination Survey 2009 to 2010 (n = 9042) showed that only 2.9% and 7.7% of children/adolescents (2-18 years) and adults (≥19 years) consumed at least 3 WG oz eq/d, respectively. For children/adolescents and adults, individuals in the high WG intake group were 59 and 76 times more likely to fall in the third fiber tertile, respectively, compared with those with no-WG intake. Total dietary fiber intake from food sources varied by WG intake group for children/adolescents and adults with more total dietary fiber consumed from ready-to-eat (RTE) and hot cereals and yeast breads/rolls in the high WG intake group compared with the no-WG intake group. Major WG sources for children/adolescents and adults included yeast bread/rolls (24% and 27%, respectively), RTE cereals (25% and 20%, respectively), and oatmeal (12% and 21%, respectively). Among those with the highest WG intake, WG RTE cereal with no added bran was the greatest contributor to total dietary fiber compared with other RTE cereal types. Whole grain foods make a substantial contribution to total dietary fiber intake and should be promoted to meet recommendations.     

Human papillomavirus vaccine coverage in the United States, National Health and Nutrition Examination Survey, 2007-2008

Objectives

This study aims to estimate human papillomavirus (HPV) vaccine coverage by demographic and sexual behavior characteristics 1-2 years after vaccine licensure in a nationally representative sample of females aged 9-59 years in the United States.

Methods

In 2007-2008, a total of 2775 females aged 9-59 years responded to questions on HPV vaccine receipt in the National Health and Nutrition Examination Survey (NHANES). Demographic and sexual characteristics were evaluated for select age categories in bivariate analyses after adjusting for survey design.

Results

Overall, 15.2% of females aged 11-26 years reported HPV vaccine initiation; vaccine initiation varied significantly by age. We found no significant difference in vaccine initiation by race or poverty level in either 11-18 or 19-26-year olds. Significantly more 19-26-year olds with private insurance initiated vaccine (16.3%) than those with public insurance (4.0%) (p = 0.04). Among females aged 14-18 years, vaccine initiation was higher in those who ever had sex (28.6%) compared to those who had never had sex (17.8%) (p = 0.05).

Conclusions

These results describe HPV vaccine initiation shortly after vaccine licensure. Vaccine initiation was highest in females aged 14-18 years. Efforts should be made to increase HPV vaccine coverage for the recommended age groups.     

Iron Deficiency Is Associated with Food Insecurity in Pregnant Females in the United States: National Health and Nutrition Examination Survey 1999-2010

Food-insecure pregnant females may be at greater risk of iron deficiency (ID) because nutrition needs increase and more resources are needed to secure food during pregnancy. This may result in a higher risk of infant low birth weight and possibly cognitive impairment in the neonate. The relationships of food insecurity and poverty income ratio (PIR) with iron intake and ID among pregnant females in the United States were investigated using National Health and Nutrition Examination Survey 1999-2010 data (n=1,045). Food security status was classified using the US Food Security Survey Module. One 24-hour dietary recall and a 30-day supplement recall were used to assess iron intake. Ferritin, soluble transferrin receptor, or total body iron classified ID. Difference of supplement intake prevalence, difference in mean iron intake, and association of ID and food security status or PIR were assessed using χ² analysis, Student t test, and logistic regression analysis (adjusted for age, race, survey year, PIR/food security status, education, parity, trimester, smoking, C-reactive protein level, and health insurance coverage), respectively. Mean dietary iron intake was similar among groups. Mean supplemental and total iron intake were lower, whereas odds of ID, classified by ferritin status, were 2.90 times higher for food-insecure pregnant females compared with food-secure pregnant females. Other indicators of ID were not associated with food security status. PIR was not associated with iron intake or ID. Food insecurity status may be a better indicator compared with income status to identify populations at whom to direct interventions aimed at improving access and education regarding iron-rich foods and supplements.     

The feasibility of a Paleolithic diet for low-income consumers

Many low-income consumers face a limited budget for food purchases. The United States Department of Agriculture developed the Thrifty Food Plan to address this problem of consuming a healthy diet given a budget constraint. This dietary optimization program uses common food choices to build a suitable diet. In this article, the United States Department of Agriculture data sets are used to test the feasibility of consuming a Paleolithic diet given a limited budget. The Paleolithic diet is described as the diet that humans are genetically adapted to, containing only the preagricultural food groups of meat, seafood, fruits, vegetables, and nuts. Constraints were applied to the diet optimization model to restrict grains, dairy, and certain other food categories. Constraints were also applied for macronutrients, micronutrients, and long-chain polyunsaturated fatty acids. The results show that it is possible to consume a Paleolithic diet given the constraints. However, the diet does fall short of meeting the daily recommended intakes for certain micronutrients. A 9.3% increase in income is needed to consume a Paleolithic diet that meets all daily recommended intakes except for calcium.     

Lean beef contributes significant amounts of key nutrients to the diets of US adults: National Health and Nutrition Examination Survey 1999-2004

Consumption of lean meat is a valuable addition to a healthy diet because it provides complete protein and is a rich source of vitamin B₁₂, iron, and zinc. The objective of this study was to examine the nutritional contribution of total beef and lean beef (LB) to the American diet using the USDA definition of LB as defined in MyPyramid. Twenty-four-hour dietary recall data from adults 19 to 50 years of age (n = 7049) and 51+ years (n = 6243) participating in the National Health and Nutrition Examination Survey 1999-2004 were assessed. Lean beef was defined as beef with <9.28 g fat per 100 g (excess was discretionary fat). Fifty percent of adults 19 to 50 years and 41% of adults 51+ years consumed beef on the day of the dietary recall. Total beef consumed among adults 19 to 50 and 51+ years was 49.3 ± 1.4 g (1.74 oz/d) and 37.1 ± 1.2 g (1.31 oz/d), respectively. In adults 19 to 50 and 51+ years, LB contributed 3.9% and 3.7% to total energy; 4.5% and 4.1% to total fat, 3.8% and 3.6% to saturated fatty acids; 13% and 11% to cholesterol intake; 15% and 14% to protein; 25% and 20% to vitamin B₁₂; 23% and 20% to zinc; and 8% and 7% to iron, respectively. Beef was also an important food source of many other nutrients, including niacin, vitamin B₆, phosphorus, and potassium. In addition, beef provided only 1% of total sodium intake. Consumption of beef contributed significantly to intake of protein and other key nutrients by US adults.     

Healthy Eating Index-2015 Scores Vary by Types of Food Outlets in the United States

Diet quality in the United States is improving over time but remains poor. Food outlets influence diet quality and represent the environments in which individuals make choices about food purchases and intake. The objective of this study was to use the Healthy Eating Index-2015 (HEI-2015) to evaluate the quality of foods consumed from the four major outlets where food is obtained—stores, full-service restaurants, quick-services restaurants, and schools—and to assess changes over time. This cross-sectional study used 24 h dietary recall data from eight cycles (2003–2004 to 2017–2018) of the National Health and Nutrition Examination Survey (NHANES). Linear trend estimation was used to test for changes in HEI scores over time, and balanced repeated replicate weighted linear regression was used to test for differences in total and component scores between types of food outlets. Overall, Americans are not consuming a mix of foods from any major category of food outlet that aligns with dietary guidelines. The total score for schools (65/100 points) and stores (62/100 points) was significantly higher than full-service (51/100 points) and quick-service (39/100 points) restaurants (p < 0.0001). HEI scores significantly improved over time for schools (p < 0.001), including an increase in whole grains from less than 1 point in 2003–2004 to 7 out of 10 points in 2017–2018. In 2017–2018, schools received the maximum score for total fruits, whole fruits, and dairy. Continued research on strategies for improving the quality of foods consumed from restaurants and stores is warranted.     

Ethnic differences in food sources of vitamin D in adolescent American girls: the National Heart, Lung, and Blood Institute Growth and Health Study

The National Heart, Lung, and Blood Institute Growth and Health Study was a 10-year longitudinal study of the development of obesity and cardiovascular disease risk factors (including dietary, psychosocial, environmental, and others) in 2379 African American and white girls who were 9 or 10 years old at study entry. Current studies have documented a high prevalence of vitamin D insufficiency among healthy children, adolescents, and young adults in the United States, especially among low-income, black, and Hispanic children (defined as serum 25-hydroxyvitamin D concentrations of <20 ng/mL). Although the main source of vitamin D is direct exposure of the skin to ultraviolet rays from sunlight, certain foods contribute vitamin D including fortified milk, meat, eggs, oils, and fortified cereals. Vulnerable subgroups that are especially at risk for inadequate intakes of vitamin D include teenage girls and women. Research providing the prevalent food sources of vitamin D, especially in the diets of both white and African American female adolescents is limited. The purpose of this study is to document food sources of vitamin D reported by this biracial young cohort and compare potential ethnic or other differences that could enhance tailored dietary interventions that are particularly relevant to this vulnerable population subgroup.     

Prevalence and correlates of vitamin D deficiency in US adults

Mounting evidence suggests that vitamin D deficiency could be linked to several chronic diseases, including cardiovascular disease and cancer. The purpose of this study was to examine the prevalence of vitamin D deficiency and its correlates to test the hypothesis that vitamin D deficiency was common in the US population, especially in certain minority groups. The National Health and Nutrition Examination Survey 2005 to 2006 data were analyzed for vitamin D levels in adult participants (N = 4495). Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D concentrations ≤20 ng/mL (50 nmol/L). The overall prevalence rate of vitamin D deficiency was 41.6%, with the highest rate seen in blacks (82.1%), followed by Hispanics (69.2%). Vitamin D deficiency was significantly more common among those who had no college education, were obese, with a poor health status, hypertension, low high-density lipoprotein cholesterol level, or not consuming milk daily (all P < .001). Multivariate analyses showed that being from a non-white race, not college educated, obese, having low high-density lipoprotein cholesterol, poor health, and no daily milk consumption were all significantly, independently associated with vitamin D deficiency (all P < .05). In summary, vitamin D deficiency was common in the US population, especially among blacks and Hispanics. Given that vitamin D deficiency is linked to some of the important risk factors of leading causes of death in the United States, it is important that health professionals are aware of this connection and offer dietary and other intervention strategies to correct vitamin D deficiency, especially in minority groups.     

Estimation of vitamin K intake in Koreans and determination of the primary vitamin K-containing food sources based on the fifth Korean National Health and Nutrition Examination Survey (2010-2011)

There is little information on dietary vitamin K intake and nutritional status of daily requirements of vitamin K in Korea. The objective of this study was to investigate the vitamin K intake and major food sources of Vitamin K in Koreans. The survey data from the 2010-2011 Korean National Health and Nutrition Examination Survey of 7,792 subjects (aged 19-64 years) were examined. Total vitamin K intake was calculated from 24-hour dietary recall using a vitamin K food database, Computer Aided Nutritional analysis Program and the United States Department of Agriculture database. The geometric mean of vitamin K was estimated as 322.40 ± 6.33 ug/day for men and 271.20 ± 4.92 ug/day for women. Daily vitamin K intake increased significantly with age (p for trend < 0.001). The main food source of vitamin K was vegetables (72.84%), including cabbage kimchi (19.26%), spinach (17.38%), sesame leaves (7.11%), radish leaves (6.65%), spring onions (6.28%), and laver (4.82%), followed by seaweed, seasonings, and fat and oils. We observed that the vitamin K intake of Koreans was relatively higher than that reported by other studies in Western countries and differed depending on age.     

Intake of added sugars is not associated with weight measures in children 6 to 18 years: National Health and Nutrition Examination Surveys 2003-2006

Studies examining an association between consumption of added sugars (AS) and weight measures in children are inconclusive. This study examined the association between intake of AS and 5 measures of weight or adiposity using a nationally recent representative sample of children. National Health and Nutrition Examination Surveys 2003-2006 24-hour recall data from children 6 to 18 years (n = 3136) were used. United States Department of Agriculture's definition of AS and MyPyramid Equivalents Database were used to estimate daily intake. Multiple linear regression and squared partial correlation coefficients were used to estimate the strength of association between weight, body mass index (BMI), BMI Z scores, waist circumference, and triceps and subscapular skinfolds as dependent variables with AS as the independent variable. Covariates were age, sex, race/ethnicity, poverty income ratio, total energy intake (kJ), and physical activity. Mean intake of AS was 23 ± 0.55 teaspoons (tsp) (21 tsp for 6-11 years and 25 tsp for 12-18 years) accounting for 17% of total energy intake for both groups. The percent variance explained in BMI Z scores was 3.9% in children 6 to 11 years, with AS contributing only 0.03%. In children 12 to 18 years, the percent variance explained in the BMI Z scores was 6.5% with 0.18% coming from AS. No significant associations were observed between intake of AS and weight or adiposity measures. Consumption of AS did not contribute significantly to BMI Z scores in children 6 to 18 years. Longitudinal studies using more robust and precise measures of dietary intake are needed to further investigate the role of AS and weight in children.     

Distributions and Trends of Serum Lipid Levels among United States Children and Adolescents Ages 4–19 Years: Data from the Third National Health and Nutrition Examination Survey

Background.Atherosclerosis begins in childhood and progresses into adulthood. The reduction of cardiovascular risk factors, such as elevated serum total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels, in childhood may reduce cardiovascular morbidity and mortality in adulthood. Lipid distributions among children and adolescents were examined using the most recent nationally representative data.Methods.Data from 7,499 examinees in NHANES III (1988–1994) were used to estimate mean and percentile distributions of serum total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides in children and adolescents aged 4 to 19 years. The estimates were analyzed by age, sex, and race/ethnic groups. Trends in mean total cholesterol were examined for 12- to 17-year-olds using data from NHES III (1966–1970), NHANES I (1971–1974), and NHANES III (1988–1994).Results.For children and adolescents 4 to 19 years of age, the 95th percentile for serum total cholesterol was 216 mg/dL and the 75th percentile was 181 mg/dL. Mean age-specific total cholesterol levels peaked at 171 mg/dL at 9–11 years of age and fell thereafter. Females had significantly higher mean total cholesterol and LDL-C levels than did males (P< 0.005). Non-Hispanic black children and adolescents had significantly higher mean total cholesterol, LDL-C, and HDL-C levels compared to non-Hispanic white and Mexican American children and adolescents. The mean total cholesterol level among 12- to 17-year-olds decreased by 7 mg/dL from 1966–1970 to 1988–1994 and is consistent with, but less than, observed trends in adults. Black females have experienced the smallest decline between surveys.Conclusions.The findings provide a picture of the lipid distribution among U.S. children and adolescents and indicate that, like adults, adolescents have experienced a fall in total cholesterol levels. Total cholesterol levels in U.S. adolescents declined from the late 1960s to the early 1990s by an average of 7 mg/dL. This information is useful for planning programs targeting the prevention of cardiovascular disease beginning with the development of heathy lifestyles in childhood.     

Dried fruit consumption is associated with improved diet quality and reduced obesity in US adults: National Health and Nutrition Examination Survey, 1999-2004

Epidemiological studies examining potential associations between dried fruit consumption, diet quality, and weight status are lacking. The goal of this study was to examine the association of dried fruit consumption with nutrient intake, diet quality, and anthropometric indicators of overweight/obesity. A secondary analysis of dietary and anthropometric data collected from adult (19+ years) participants (n = 13 292) of the 1999-2004 National Health and Nutrition Examination Survey was conducted. Dried fruit consumers were defined as those consuming amounts ? cup-equivalent fruit per day or more and identified using 24-hour recalls. Diet quality was measured using the Healthy Eating Index 2005. Covariate-adjusted means, SEs, prevalence rates, and odds ratios were determined to conduct statistical tests for differences between dried fruit consumers and nonconsumers. Seven percent of the population consumed dried fruit. Mean differences (P < .01) between consumers and nonconsumers in adult shortfall nutrients were dietary fiber (+6.6 g/d); vitamins A (+173 μg retinol activity equivalent per day), E (+1.5 mg α-tocopherol per day), C (+20 mg/d), and K (+20 mg/d); calcium (+103 mg/d); phosphorus (+126 mg/d); magnesium (+72 mg/d); and potassium (+432 mg/d). Dried fruit consumers had improved MyPyramid food intake, including lower solid fats/alcohol/added sugars intake, and a higher solid fats/alcohol/added sugars score (11.1 ± 0.2 vs 8.2 ± 0.1) than nonconsumers. The total Healthy Eating Index 2005 score was significantly higher (P < .01) in consumers (59.3 ± 0.5) than nonconsumers (49.4 ± 0.3). Covariate-adjusted weight (78.2 ± 0.6 vs 80.7 ± 0.3 kg), body mass index (27.1 ± 0.2 vs 28.1 ± 0.2), and waist circumference (94.0 ± 0.5 vs 96.5 ± 0.2 cm) were lower (P < .01) in consumers than nonconsumers, respectively. Dried fruit consumption was associated with improved nutrient intakes, a higher overall diet quality score, and lower body weight/adiposity measures.     

Vitamin E,vitamin A,and zinc status are not related to serologic response to influenza vaccine in older adults: an observational prospective cohort study

It has been hypothesized that micronutrient levels play a role in the immune response to vaccination; however, population-level research on the association between micronutrient levels and immune response to influenza vaccination is needed. In this study, we hypothesized that decreasing levels of nutrients would be associated with decreased hemagglutination inhibition (HAI) responses to influenza vaccination. Therefore, the purpose of this study was to determine whether serum vitamin A, vitamin E, or zinc levels are associated with influenza vaccine response determined by HAI titer in adults 65 years or older. Participants in this study included 205 community-dwelling adults 65 years or older who resided in Marshfield, WI, USA, from fall 2008 through spring 2009. Participants received trivalent influenza vaccine and donated blood samples before and 21 to 28 days after vaccination. Prevaccination levels of serum retinol, α-tocopherol, and zinc as well as prevaccination and postvaccination HAI titer levels were measured. No participants were vitamin A or vitamin E deficient; 20% had low serum zinc levels (<70 μg/dL). Continuous variables and categorical quartiles coding for vitamin A, vitamin E, and zinc levels were not related to prevaccination or postvaccination seroprotection or seroconversion for any of the vaccine components (influenza A [H1N1], A [H3N2], or B), after adjusting for age, sex, body mass index, and prevaccination HAI geometric mean titer. In conclusion, our study population showed no association between variations in levels of serum vitamin A, vitamin E, or zinc and influenza vaccine response as measured by HAI in adults older than 65 years. Thus, associations between micronutrients and other measures of vaccine response, such as cell-mediated immune parameters, should also be explored.