Prevalent Nutrient Deficiencies in the US: More Than 40% are Vitamin A, C, D & E, Calcium or Magnesium Deficient and >90% Don't Get Enough Choline, Fiber & Potassium

Choline, fiber, potassium, this meal has everything US citizens don't eat.

The latest re-examination of data from the 2001-2008 National Health and Nutrition Examination Survey (NHANES) reveals: " A substantial proportion of the adult population (over 40%) had inadequate intakes of vitamin A, vitamin C, vitamin D, vitamin E, calcium, and magnesium." (Agarwal. 2014)

While many studies have examined the differences in micronutrient intakes in various population subgroups, very few studies have compared the micronutrient intake status of overweight and/or obese with that of normal weight adults. A highly relevant distinction as it turns out.

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In view of the fact that more than two thirds of the U.S. population is either overweight or obese and represents a population subgroup with higher risk of several chronic diseases, including cardiovascular disease and diabetes, one of the main goals of the latest reanalysis of data from the NHANES study included a differential analysis to determine, whether there are differences between lean and obese individuals when it comes to the amount of micronutrients they consume.

This subgroup analysis is also important, because scientists have repeatedly speculated that nutrient deficiencies may contribute to the rapid increase in US obesity rates over the past decades. In view of the fact that micronutrient deficiencies can occur as a result of both, an insufficient intake and in response to altered absorption and metabolism, the results of the study at hand may offer important insights into possible set screws that may help to prevent a further increase in the US obesity rate.

Figure 1: Percentage of the adult population (aged 19 years) with vitamin and mineral intakes below the EAR for individuals (data from NHANES 2001–2008). Usual intakes from foods were estimated by using the National Cancer Institute (NCI) method (Agarwal. 2014).

In the analysis for the whole population the aforementioned micronutrients, i.e. vitamin A, C, D & E, as well as the macrominerals calcium and magnesium are those most US citizens don't get enough of. This does also mean that alleged deficiency nutrients like selenium or B12 are actually no deficiency nutrients, when it comes to dietary intakes. Nutrients like zinc, B6, folate and even iron, are "deficiency nutrients" for some, but not the majority of American citizens.

Lean vs. overweight & obese - is there a difference?

The researchers were also able to show that the proportion of adults with intakes below the EAR also differed significantly by body weight status (Figure 2). In that, a significantly greater percentage of obese adults compared to normal weight adults had intakes that did not meet the EAR for vitamin A, vitamin C, vitamin D, vitamin E, calcium, and magnesium (p < 0.01).

Figure 2: Percentage of the adult population (aged 19 years) by body weight status with vitamin and mineral intakes below the EAR for individuals (data from NHANES 2001–2008). Usual intakes from foods were estimated by using the National Cancer Institute method. a,b,c Bars with different letters are significantly different at p < 0.05 (Agarwal. 2014).

About 20% more obese adults compared to normal weight adults had intakes that did not meet EAR for vitamin A, vitamin C, and magnesium. For calcium, 10% more obese adults compared to normal weight adults had inadequate intakes. Furthermore, the prevalence of inadequacy for vitamin D and vitamin E among obese adults was also significantly higher (p < 0.05) than among normal weight adults but the difference was only 2.8% and 3.3%, respectively.

What about supplements? The study at hand evaluated the total intake. It is thus not surprising that those US citizens who take multivitamins & co had a lower prevalence of inadequacy of micronutrients compared to nonusers. Furthermore Agarwal et al. were able to show that "supplement users are more likely to have healthier diets compared to nonusers" (Agarwal. 2014) - a result that is in line with results of previous investigations, by the way.

Figure 3: Percentage of the adult population (aged 19 years) by body weight status with vitamin and mineral and fiber intakes above the AI for individuals (data from NHANES 2001–2008). Usual intakes from foods were estimated by using the National Cancer Institute method. a, b,cBars with different letters are significantly different at p < 0.05 (Agarwal. 2014).

For potassium and fiber, the proportion of adults with intakes above AI also differed slightly but significantly by body weight status (Figure 3). About 1.5% and 2% fewer obese adults compared to normal weight adults had intakes above AI for potassium and fiber, respectively. No significant differences by body weight status were noted for choline.

Since all three of them have been associated with metabolic and cardiovascular health, respectively, the insufficient intake of these allegedly "non essential" nutrients (this is why there is no RDA for them) could be as much of a problem as the lack of any of the literally vital vitamins.

In their discussion of the results, the researchers from NutrieScienceLLC highlight that their study is the first study reporting inadequate intake and high prevalence of micronutrient inadequacy in a nationally representative sample of overweight and obese U.S. adults using mean usual intakes determined by the NCI method.

Must Read I: Potassium Deficiency, Bone & Protein Loss, Stroke, Heart Disease & High Mortality | more

Choline Deficiency, Its Myriad of Ill Health Effects and How You Can Easily Fix It | read more

As far as the reasons are concerned, the Agarval et al. were able to show that the  lower intakes of micronutrients such as vitamin A (b-carotene), vitamin C, fiber, magnesium, calcium, and vitamin D, which are commonly found in fruits, vegetables, whole grains, and dairy are in fact related to "poor dietary choices" among obese adults. More specifically the data shows that ...

• the intake of fruit and dairy was significantly lower among obese adults compared to normal weight adults, and
• the healthy eating index, a measure of how close someone eats to the dietary recommendation for obese adults was slightly but significantly lower compared to normal weight adults

Due to the overall insufficient vegetable intake of the average American, Agarval et al. were unable to detect a difference in terms of the amounts of veggies obese and normal-weight US citizens consume.

Figure 4: Usual Intakes of Parameters of Diet Quality of Adults (age 19 years) by Body Weight Status (Agerwal. 2014)

While the former may be disappointing, but probably expected you will be surprised, and the anti-sugar warriors out there disappointed, to hear that the added sugar intake "was found to be higher in normal weight adults compared to obese adults" (Agarwal. 2014 | my emphasis). Whether that's an accurate reflection of the real sugar intake is yet as questionable as the overall lower energy intake of obese individuals. The results are after all based on questionnaires and as harsh as it may sound: Obese individuals are scientifically convicted liars, when it comes to statements about their energy intakes. Poppitt et al. (1998), for example, were able to show that

"[...r]eported total carbohydrate and added sugar intakes were significantly lower than measured, whilst reported protein and fat intakes were not significantly different from measured " (Poppit. 1998).

And Heitman et al. (1995) and more recently Meng et al. (2013) highlight that the degree of obesity was positively associated with underreporting of total energy intakes.

Increasing your fiber intake, may save your life: Each 10g Fiber Reduce Mortality Risk by up to 34% | read more.

Bottom line: While some of the results may be messed up by under- or misreporting, the overall message of the study is clear. Almost half of the US citizens are deficient in at least one highly health-relevant nutrient.

What may be even worse, though, is the fact that there is no RDA for important dietary ingredients like choline, fiber and potassium. With no RDA being established some people may be unaware that they don't get enough of these vital nutrients. So that the lack of awareness may eventually be partly behind "deficiency rates" of 93%, 95% and whopping 97% for choline, fiber and potassium, respectively, among lean and even higher rates among overweight and obese US citizens (learn about the consequences of low potassium, choline and fiber intakes in three previous articles) | Comment on Facebook!

References:

• Agarwal, Sanjiv, et al. "Comparison of Prevalence of Inadequate Nutrient Intake Based on Body Weight Status of Adults in the United States: An Analysis of NHANES 2001–2008." Journal of the American College of Nutrition ahead-of-print (2014): 1-9.
• Heitmann, Berit Lilienthal, and Lauren Lissner. "Dietary underreporting by obese individuals--is it specific or non-specific?." Bmj 311.7011 (1995): 986-989.
• Meng, X., et al. "Under-reporting of energy intake in elderly Australian women is associated with a higher body mass index." The journal of nutrition, health & aging 17.2 (2013): 112-118.
• Poppitt, S. D., et al. "Assessment of selective under-reporting of food intake by both obese and non-obese women in a metabolic facility." International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity 22.4 (1998): 303-311.