Decreasing the Consumption of Foods with Sugar Increases Their Reinforcing Value: A Potential Barrier for Dietary Behavior Change

BackgroundThe Dietary Guidelines for Americans (DGA) have recommended reducing added sugar intake since its inception in 1980. Nearly 40 years later, added sugar consumption still exceeds 2015-2020 DGA recommendations among most of the population. The reinforcing value of food influences eating behaviors, and foods high in added sugars are highly reinforcing. Restricting intake of foods high in added sugars as part of a low-sugar diet may increase their reinforcing value such that reducing consumption may be difficult to maintain. If so, this would present a mechanistic barrier to making the necessary dietary changes to meet 2015-2020 DGA recommendations.PurposeTo determine whether the relative reinforcing value of foods high in added sugars is altered when reducing intake of all foods high in sugars.MethodsObese (n=19) and normal weight (n=23) men and woman who habitually consumed over 10% of their calories from added sugars completed the study. Reinforcing value of foods high in added sugars was measured via progressive ratio schedules of reinforcement before and on day 7 of a weeklong controlled feeding intervention where added sugars comprised 2.5% to 4.0% of daily calories and total sugars 7.3% to 8.6% of daily calories.ResultsThe reinforcing value of foods high in added sugars increased (P<0.01) after consuming a diet low in total added sugars for 1 week in both obese and normal weight participants.ConclusionAdhering to a low-sugar diet for 1 week increases the reinforcing value of foods high in added sugars. Future studies should examine whether consuming a diet low in added sugars, but not other sugar, increases reinforcing value of foods high in added sugars and whether high–added sugar food reinforcement returns to baseline after longer-term reductions in added sugars.     

Added Sugars Intake among US Infants and Toddlers

BackgroundLimited information is available on added sugars consumption in US infants and toddlers.ObjectivesTo present national estimates of added sugars intake among US infants and toddlers by sociodemographic characteristics, to identify top sources of added sugars, and to examine trends in added sugars intake.DesignCross-sectional analysis of 1 day of 24-hour dietary recall data.Participants/settingA nationally representative sample of US infants aged 0 to 11 months and toddlers aged 12 to 23 months (n=1,211) during the period from 2011 through 2016 from the National Health and Nutrition Examination Survey. Trends were assessed from 2005-2006 through 2015-2016 (n=2,795).Main outcome measuresAmong infants and toddlers, the proportion consuming any added sugars, the average amount of added sugars consumed, percent of total energy from added sugars, and top sources of added sugars intake.Statistical analysisPaired t tests were used to compare differences by age, sex, race/Hispanic origin, family income level, and head of household education level. Trends were tested using orthogonal polynomials. Significance was set at P<0.05.ResultsDuring 2011 to 2016, 84.4% of infants and toddlers consumed added sugars on a given day. A greater proportion of toddlers (98.3%) consumed added sugars than infants (60.6%). The mean amount of added sugars toddlers consumed was also more compared with infants (5.8 vs 0.9 tsp). Non-Hispanic black toddlers (8.2 tsp) consumed more added sugars than non-Hispanic Asian (3.7 tsp), non-Hispanic white (5.3 tsp), and Hispanic (5.9 tsp) toddlers. A similar pattern was observed for percent energy from added sugars. For infants, top sources of added sugars were yogurt, baby food snacks/sweets, and sweet bakery products; top sources among toddlers were fruit drinks, sugars/sweets, and sweet bakery products. The mean amount of added sugars decreased from 2005-2006 through 2015-2016 for both age groups; however, percent energy from added sugars only decreased among infants.ConclusionAdded sugars intake was observed among infants/toddlers and varied by age and race and Hispanic origin. Added sugars intake, as a percent of energy, decreased only among infants from 2005 to 2016.     

Processed Food Contributions to Energy and Nutrient Intake Differ among US Children by Race/Ethnicity

This study determined and compared the mean daily intake of energy and nutrients from processed foods by level of processing (minimally processed; processed for preservation, nutrient enhancement, and freshness; mixtures of combined ingredients; ready-to-eat processed foods; and prepared foods/meals) among non-Hispanic white, non-Hispanic black, and Mexican American US children. Data from participants 2–18 years old (n = 10,298) of the nationally representative cross-sectional National Health and Nutrition Examination Survey 2003–2008 with a complete one day, 24-h dietary recall were used to determine mean intake of energy and nutrients recommended for increase and decrease, as per the 2010 Dietary Guidelines for Americans, among child race/ethnic groups by category of food processing. Regression analysis was used to estimate and compare covariate-adjusted (gender, age, and poverty-income-level) least square means (p < 0.05/3 race/ethnic groups). All children, regardless of race or ethnicity consumed processed foods. Approximately 66% to 84% of total daily energy, saturated fat, cholesterol, fiber, total sugar, added sugars, calcium, vitamin D, potassium, and sodium intake are contributed by one of the five categories of processed foods. Clinicians and policy should primarily advise consideration of the energy and nutrient composition of foods, rather than the processing level, when selecting a healthy diet for children.     

Association between Ultra-processed Food Consumption and Dietary Intake and Diet Quality in Korean Adults

BackgroundFood environments have changed rapidly, and the global interest in ultra-processed foods has increased. Ultra-processed foods are typically energy dense, high in sugars and fat, and low in fiber, protein, minerals, and vitamins.ObjectiveThis study aimed to estimate the energy contribution of ultra-processed foods in the diet of Korean adults and to examine the association between ultra-processed food consumption and dietary intake and diet quality.DesignThis study is a secondary analysis of cross-sectional data from the Korea National Health and Nutrition Examination Survey (2016–2018).Participants/settingsA total of 16,657 adults aged ≥19 years who completed a 1-day 24-hour recall.Main outcome measuresAbsolute and relative intake of energy and nutrients were measured and dietary quality was assessed using the Korean Healthy Eating Index (KHEI).Statistical analysisMultiple regression models adjusted for sociodemographic variables were used to examine the association between quintiles of ultra-processed foods dietary energy contribution and dietary intake and quality.ResultsMean reported daily energy intake was 2,031 kcal, with 25.1% of calories coming from ultra-processed foods. Mean energy contribution from ultra-processed foods ranged from 3.6% kcal (Q1) to 52.4% kcal (Q5). Energy contribution of ultra-processed foods was positively associated with reported intake of daily energy, total sugars, and total and saturated fat and inversely associated with reported intake of carbohydrates, fiber, minerals, and vitamins. Both sodium and potassium were negatively associated with percentage of energy from ultra-processed foods. However, the sodium-to-potassium ratio was high regardless of quintile of energy contribution from ultra-processed foods, and the ratio was positively associated with percentage of total energy from ultra-processed foods. Although the KHEI score was inversely associated with percentage of daily energy from ultra-processed foods, all levels of ultra-processed food consumption were associated with poor diet quality.ConclusionsThe ultra-processed foods consumption of Korean adults accounted for one fourth of daily energy intake, and a higher dietary energy contribution from ultra-processed foods was associated with poorer dietary intakes and a lower dietary quality. Further studies are needed to understand factors influencing selection and consumption of ultra-processed foods and to identify effective strategies to promote healthy food choices.     

Impact of Typical Rather than Nutrient-Dense Food Choices in the US Department of Agriculture Food Patterns

BackgroundThe US Department of Agriculture (USDA) Food Patterns, released as part of the 2010 Dietary Guidelines for Americans, are designed to meet nutrient needs without exceeding energy requirements. They identify amounts to consume from each food group and recommend that nutrient-dense forms—lean or low-fat, without added sugars or salt—be consumed. Americans fall short of most food group intake targets and do not consume foods in nutrient-dense forms. Intake of calories from solid fats and added sugars exceed maximum limits by large margins.ObjectiveOur aim was to determine the potential effect on meeting USDA Food Pattern nutrient adequacy and moderation goals if Americans consumed the recommended quantities from each food group, but did not implement the advice to select nutrient-dense forms of food and instead made more typical food choices.DesignFood-pattern modeling analysis using the USDA Food Patterns, which are structured to allow modifications in one or more aspects of the patterns, was used. Nutrient profiles for each food group were modified by replacing each nutrient-dense representative food with a similar but typical choice. Typical nutrient profiles were used to determine the energy and nutrient content of the food patterns.ResultsModeration goals are not met when amounts of food in the USDA Food Patterns are followed and typical rather than nutrient-dense food choices are made. Energy, total fat, saturated fat, and sodium exceed limits in all patterns, often by substantial margins. With typical choices, calories were 15% to 30% (ie, 350 to 450 kcal) above the target calorie level for each pattern. Adequacy goals were not substantially affected by the use of typical food choices.ConclusionsIf consumers consume the recommended quantities from each food group and subgroup, but fail to choose foods in low-fat, no-added-sugars, and low-sodium forms, they will not meet the USDA Food Patterns moderation goals or the 2010 Dietary Guidelines for Americans.     

Associations between Consumption of Ultra-Processed Foods and Intake of Nutrients Related to Chronic Non-Communicable Diseases in Mexico

BackgroundUltra-processed foods are highly palatable and can be consumed anywhere at any time, but typically have a poor nutritional profile. Therefore, their contribution to total energy intake has been proposed as an indicator for studying overall dietary quality.ObjectiveThe aim of this study was to investigate the associations between the energy contribution from ultra-processed foods and the intake of nutrients related to chronic non-communicable diseases in Mexico.DesignThis study used a secondary analysis of cross-sectional data from the 2012 Mexican National Health and Nutrition Survey.Participants/settingThis study included participants aged 1 year and older (n=10,087) who had completed a 1-day 24-hour recall.Main outcome measuresIntake from added sugar (% kcal), total fat (% kcal), saturated fat (% kcal), protein (% kcal), dietary fiber (g/1,000 kcal), and dietary energy density (kcal/g) were measured.Statistical analysisMultiple linear regression models adjusted for sociodemographic variables were fitted to assess the association between quintiles of energy contribution from ultra-processed foods and nutrient intake.ResultsMean reported energy contribution from ultra-processed foods to the Mexican population’s diet ranged from 4.5% kcal in quintile 1 (Q1) to 64.2% kcal in quintile 5 (Q5). An increased energy contribution from ultra-processed foods was positively associated with intake from added sugar (Q1: 7.4% kcal; Q5: 17.5% kcal), total fat (Q1: 30.6% kcal; Q5: 33.5% kcal) and saturated fat (Q1: 9.3% kcal; Q5: 13.2% kcal), as well as dietary energy density (Q1: 1.4 kcal/g; Q5: 2.0 kcal/g) (P≤0.001); and inversely associated with intake from protein (Q1: 15.1% kcal; Q5: 11.9% kcal) and dietary fiber (Q1: 16.0 g/1,000 kcal; Q5: 8.4 g/1,000 kcal) (P≤0.001).ConclusionsIn the Mexican population, an increased energy contribution from ultra-processed foods was associated with a lower dietary quality with regard to intake of nutrients related to chronic non-communicable diseases. Future research is needed to identify barriers to eating a variety of unprocessed and minimally processed foods for the Mexican population, as well as effective public health strategies and policies to overcome these barriers.     

Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods

We assessed the adequacy of nutrient intakes of 135 rural Bangladeshi breast-fed infants 6-12 mo of age and examined nutritional trade-offs due to possible displacement of breast milk by complementary foods. Observers completed 12-h daytime measurements of breast milk and complementary food intakes; data for the previous 12 h were obtained from maternal recall, yielding estimates of total 24-h intakes. On average, infants were mildly wasted (mean +/- SD weight-for-length Z-score = -0.92 +/- 0.88) and moderately stunted (length-for-age Z-score = -1.49 +/- 0.96). Total energy intakes at 6-8 and 9-12 mo were 88 and 86% of absolute energy requirements (kJ/d), 106 and 105% of requirements per kg body weight, and 97 and 94% of requirements per kg median weight-for-length, respectively. Breast milk contributed 78% of energy intake at 6-8 mo and 75% at 9-12 mo. Mean meal frequency and energy density of complementary foods were generally consistent with recommendations, but only small amounts of food were offered. Nevertheless, only 72% of the food energy offered was consumed. Total energy intake was positively correlated with meal frequency, quantity consumed per meal, and energy intake from breast milk, but not with energy density of complementary foods. Energy intake from complementary foods was inversely related to energy intake from breast milk. The diets fell short of recommended intakes for numerous vitamins and minerals. We conclude that although greater intakes of complementary foods were associated with higher total energy intake, micronutrient intake remained low due to the low micronutrient density of the complementary foods consumed and the partial displacement of breast milk.     

Dietary Intakes of Children Enrolled in US Early Child-Care Programs During Child-Care and Non-Child-Care Days

BackgroundEarly-child-care (ECE) programs may substantially influence child diet quality.ObjectiveThe Study of Nutrition and Activity in Child Care Settings describes the usual food group intake of preschool-aged children attending ECE programs relative to Dietary Guidelines for Americans (DGA) recommendations, comparing intakes during child-care and non-child-care days.DesignMeal observations and parent-completed food diaries in a cross-sectional nationally representative multistage cluster sample of Child and Adult Care Food Program-participating ECE programs.Participants/settingOne thousand four hundred sixty-eight children aged 3 to 5 years attending 217 Child and Adult Care Food Program-participating ECE programs (eg, child-care centers and Head Start) during 2017.Main outcome measuresDaily energy intake, daily US Department of Agriculture Food Pattern Food Group intakes, and percentage of daily intakes meeting 2015-2020 DGA Food Pattern recommendations.Statistical analyses performedRegression-adjusted usual intakes and percentage of children meeting recommendations were estimated using the National Cancer Institute method. Single-day mean intakes were used to test for statistical differences between child-care and non-child-care days.ResultsMean usual energy intake was 1,524 ± 19.3 kcal during child-care days and exceeded the recommended range at 1,702 ± 30.2 kcal during non-child-care days; single-day means indicated significantly lower energy intake on child-care days (P < 0.001). The percent of children meeting DGA recommendations on a child-care day varied by DGA food group: fruits (51.4%), grains (50.1%), dairy (42.5%), vegetables (6.5%), whole grains (4.6%), and protein foods (0.1%). Recommended limits on calories from added sugar and solid fats were met by 28.2% and 14.6% of children, respectively. Compared with mean food group intakes during a single child-care day, non-child-care day intakes were similar for fruits and vegetables, lower for dairy and whole grains, and higher for total grains, protein foods, and calories from added sugars and solid fats.ConclusionsAlthough there is room to increase nutrient density inside and outside of child care, intakes on child-care days more closely align to DGAs.     

Dietary sodium reduction among students: feasibility and acceptance

Modifications in the preparation of food served in a boarding high school during a 5-week period were successful in decreasing the sodium content of a variety of food products by an average of 51%. Such food was, in general, well accepted. The ratings of specific reduced-sodium food products equaled those of similar products containing "usual" amounts of sodium. Food diaries kept by students gave estimates of total sodium intake comparable with those measured by laboratory analysis of 24-hour food collections. Food diaries collected from an average of 70 volunteers per week indicated that during the reduced-sodium period, the total sodium intake of students, including that from dining hall food, snack food, and food consumed outside the school, decreased from 136 mEq (3 gm sodium, 8 gm salt) to 88 mEq (2 gm sodium, 5 gm salt), a reduction of 35% (p less than .0001). The impact of salt added at the table was very small; the choice and the quantity of foods consumed were the main determinants of sodium intake. The results indicate that foods can be prepared with appreciably less sodium and still be highly acceptable to young people.     

Glucose and insulin responses to manufactured and whole-food snacks

To determine whether realistic snacks containing added sugar evoke excessive insulin responses, 10 healthy subjects consumed four different snack meals, similar in fat and total energy content. Two snacks were based on sugary, manufactured products (chocolate-coated candy bar; cola drink with crisps) and two on whole foods (raisins and peanuts; bananas and peanuts). After the processed-food snacks, plasma-glucose levels tended to rise higher and to fall lower than after the whole-food snacks. The area under the plasma insulin curve was 70% greater after the manufactured snacks than after the raisin-peanut snack. The banana-peanut snack evoked an intermediate insulin response. One subject had pathological insulinaemia after both manufactured snacks but normal responses after both whole-food snacks. These findings suggest that foods and drinks containing added fiber-depleted sugars stress and sometimes overwhelm homeostatic mechanisms but also suggest that the insulin response to food is influenced by the physical state of the food.     

The effects of dieting on food and nutrient intake of lactating women

The purpose of this report was to identify and evaluate dietary changes in women who were participating in a study on the effects of weight loss in overweight lactating women on the growth of their infants. Women were randomly assigned at 4 weeks postpartum to either restrict energy intake by 500 kcal/day (diet and exercise group) or to maintain usual dietary intake (control group) for 10 weeks. The diet and exercise group significantly decreased fats, sweetened drinks, sweets and desserts, snack foods, and energy intake. Micronutrient intake decreased in the diet and exercise group; however, mean intakes were not significantly different from those of the control group except for calcium and vitamin D. Both groups consumed less than 76% of the Recommended Dietary Allowance for vitamins E and C at the end of the study. Mean intake of all other nutrients was adequate in both groups. These results suggest that overweight lactating women can restrict their energy intake by 500 kcal per day by decreasing consumption of foods high in fat and simple sugars. However, they must be advised to increase their intakes of foods high in calcium and vitamin D. Increased intake of fruits and vegetables should also be recommended to all lactating women, as well as multivitamin and calcium supplements to those who do not consume adequate amounts of these foods.     

Child Food Insecurity Is Associated with Energy Intake among Fourth- and Fifth-Grade Girls

BackgroundFood insecurity is associated with poor diet and obesity among adult women, but evidence among children is mixed, and few studies have examined differences between boys and girls.ObjectiveThis study examined the relationship between self-reported food insecurity and dietary intake among boys and girls.DesignCross-sectional survey data were used from the Children’s PowerPlay! Campaign evaluation.Participants and settingIn all, 3,547 fourth- and fifth-grade students (9 to 11 years old) from 44 San Diego-area elementary schools in 2012 completed diary-assisted 24-hour recalls and a questionnaire that included five questions from the Child Food Security Assessment.Main outcome measuresIndividual dietary components (including total energy, nutrients, and sugar-sweetened beverages), Healthy Eating Index-2010 scores, and meal patterns (such as meal sizes and missed meals) were derived from 24-hour recalls.Statistical analysesMultivariable linear and logistic regression models were used to estimate the relationships between food insecurity and diet characteristics.ResultsGirls with the highest food insecurity consumed 135 total kilocalories (P<0.005) and 60 snack kilocalories (P<0.05) more per day than girls with no food insecurity. These relationships were absent among boys.ConclusionsFood insecurity among girls in grades 4 and 5 was associated with higher energy intake. Findings support the need for further research to better understand the nature of this relationship and its implications for energy balance.     

Sodium intake from meals and snacks consumed by college students

This investigation was designed to compute the total sodium intake from meals and snacks consumed by selected college students. Most students used carbonated beverages, candies, gums, cookies, and salted snack items. They consumed salted snack items mostly as evening snacks. Mean sodium intake was found to be 3,904 mg. for men and 2,628 mg. for women, without taking into consideration the use of table salt. Sodium density per kilocalorie per day was 1.40 and 1.41 for men and women, respectively, suggesting that the differences in intakes were due to women's lower caloric intake. Sodium intake was greater from regular meals than from snack foods. Evening snacks contributed more to the daily sodium intake than morning and afternoon snacks. It can be concluded that sodium intake of college students needs careful assessment. According to the Food and Nutrition Board, the most effective way to maintain intake within the suggested range is to reduce the amount of salt added at table or in cooking and to reduce moderately the selection of obviously salty foods (9). College students need to be made aware of the sodium content of foods they select for lunch, dinner, and evening snacks, as well as the amount of salt they add at the table.     

Dietary Guidelines Are Not Met by In-Home Child Care Providers in Low-Income Areas

ObjectiveThe goals of this study were to describe (1) the dietary quality of foods and beverages served by in-home child care providers in low-income areas in Michigan and (2) the extent to which they align with the Dietary Reference Intakes and food group recommendations.DesignCross-sectional, observational. Food and beverages served were examined using direct diet observation.SettingChild care provider homes.ParticipantsIn-home child care providers (n = 116) from rural and urban Michigan counties (n = 24) were recruited from the Great Start to Quality child care database.Main Outcome MeasuresDietary quality (food groups and nutrients) of food and beverages served by 116 providers to 378 children, aged 2–5 years, for 1 lunch and a snack.AnalysisAverage food group and nutrient scores were compared with Dietary Reference Intakes and food group thresholds using the Wilcoxon rank sum test (significance at <.05).ResultsFindings indicate overserving of refined grains, protein, carbohydrates, added sugars, and sodium and underserving of whole grains and vegetables. Nutrients exceeding recommendations included vitamins A, C, and D, folate, calcium, zinc, and magnesium, whereas iron and potassium were underserved.Conclusions and ImplicationsTailored efforts are needed to address shortcomings in meeting dietary recommendations among in-home child care providers to enhance child nutrition.     

Empty calories? Nutrient intake in relation to sugar intake in English adolescents

The relation between the intake of added sugars and other nutrients was examined by analysing the diet of 405 English children aged 11–14 years. For each sex, the nutrient intake of the 30 subjects with the highest intake of added sugars in proportion to energy intake (g/MJ) was compared with the nutrient intake of the 30 subjects with the lowest intake of added sugars in proportion to energy intake. Those eating the highest amount of added sugars consumed less protein and vitamin D compared with those who ate the lowest amounts of added sugars.
Some differences in the nutrient intakes of the high and low added sugar groups were observed for girls only, and non-significant trends were observed in both sexes, tending to suggest that those consuming diets containing low levels of added sugars in proportion to energy (a low preference for sugar) ate a more nutrient-dense diet and, to some extent, supported the concept of 'empty calories'. However, when sugars intake was expressed as g weight (and not in proportion to energy), energy intake and consumption of most nutrients were considerably higher in those eating high levels of added sugars, probably because of their higher intake of foods in general.     

Nutrient intakes and body weights of persons consuming high and moderate levels of added sugars.

We classified a nationally representative sample of persons aged 4 years and older as high or moderate consumers of added sugars (ie, sugars added to foods by processors or consumers). Intake of added sugars was determined on the basis of grams consumed per kilogram of body weight (g/kg) and on the basis of percent of dietary energy from added sugars (% kcal). Regardless of the intake measure used, high consumers of added sugars had a significantly lower percentage of dietary energy from fat than did moderate consumers of added sugars. Persons defined by the % kcal measure as high consumers of added sugars took in lower percentages of the Recommended Dietary Allowances (RDAs) for 11 vitamins and minerals; these high consumers had body weights similar to those of their moderate counterparts. Persons defined as high consumers by the g/kg measure consumed greater percentages of the RDAs than did their moderate counterparts; these high consumers more frequently selected foods from categories likely to contain sugar-rich foods but weighed significantly less than did moderate consumers. Thus, different approaches to defining intake of added sugars revealed two patterns of high consumption of added sugars with different levels of nutritional risk. Conditions of overweight were not associated with high intake of added sugars. Educational efforts, therefore, should focus on those consumers who tend to substitute foods rich in added sugars for more nutritionally desirable foods.     

Nutritional composition of dishes commonly consumed by Japanese Brazilians in São Paulo,Brazil

Abstract

Primary objective To calculate the nutritional composition of commonly consumed Brazilian foods and beverages to analyze dietary intake data obtained with a quantitative food frequency questionnaire in a colorectal adenoma case–control study in Japanese Brazilians.

Methods and procedures Weighed recipes were collected in São Paulo, Brazil and analyzed using NutriBase Clinical Nutrition Manager.

Main outcomes and results A total of 387 recipes for 76 dishes commonly consumed by Japanese Brazilians were collected: 30 composite main course dishes, 26 composite vegetable dishes, 19 snack foods and desserts, and one beverage. The nutritional composition (energy and 32 macronutrients and micronutrients) was calculated per 100 g for each dish.

Conclusions We provided, for the first time, complete and up-to-date calculated nutritional composition data for commonly consumed Brazilian food items, which are essential to assess the current dietary intake among Japanese Brazilians.     

Fortified Foods Are Major Contributors to Nutrient Intakes in Diets of US Children and Adolescents

BackgroundEven in an era of obesity and dietary excess, numerous shortfall micronutrients have been identified in the diets of US children and adolescents. To help tailor strategies for meeting recommendations, it is important to know what foods contribute greatly to micronutrient intakes. Data are lacking on specific contributions made by added nutrients.ObjectiveOur aims were to examine the impact of fortification on nutrient adequacy and excess among US children and adolescents and to rank food sources of added nutrient intake and compare rankings with those based on total nutrient intake from foods.Design and statistical analysesData were from 7,250 respondents 2 to 18 years old in the National Health and Nutrition Examination Survey 2003-2006. Datasets were developed that distinguished nutrient sources: intrinsic nutrients in foods; added nutrients in foods; foods (intrinsic plus added nutrients); and total diet (foods plus supplements). The National Cancer Institute method was used to determine usual intakes of micronutrients by source. The impact of fortification on the percentages of children having intakes less than the Estimated Average Requirement and more than the Upper Tolerable Intake Level was assessed by comparing intakes from intrinsic nutrients to intakes from intrinsic plus added nutrients. Specific food sources of micronutrients were determined as sample-weighted mean intakes of total and added nutrients contributed from 56 food groupings. The percentage of intake from each grouping was determined separately for total and added nutrients.ResultsWithout added nutrients, a high percentage of all children/adolescents had inadequate intakes of numerous micronutrients, with the greatest inadequacy among older girls. Fortification reduced the percentage less than the Estimated Average Requirement for many, although not all, micronutrients without resulting in excessive intakes. Data demonstrated the powerful influence of fortification on food-source rankings.ConclusionsKnowledge about nutrient intakes and sources can help put dietary advice into a practical context. Continued monitoring of top food sources of nutrients and nutrient contributions from fortification will be important.