micronutrient enrichment & fortification make a...
TRANSCRIPT
![Page 1: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/1.jpg)
TM
Micronutrient enrichment & fortification make a difference in US diets
Johanna Dwyer, DSc, RD Jean Mayer USDA Human Nutrition Research Center on Aging Tufts University
![Page 2: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/2.jpg)
TM
Agenda
• Do enrichment and fortification make a meaningful difference in US micronutrient intakes?
• What challenges remain?
3
![Page 3: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/3.jpg)
Strategies for Increasing Nutrients
• Choose vehicle
– Foods • with naturally occurring nutrients • added nutrients (fortification, enrichment)
– Dietary supplements
• Get target group to eat/use enough to deliver the desired amount
4 TM
![Page 4: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/4.jpg)
Fortification Criteria
• Safe • Effective • Benefits nutritional status of population • Not excessive or harmful (espescially if many
foods fortified with same nutrients and supplements used)
• Label
6 TM
![Page 5: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/5.jpg)
To increase micronutrient intakes foods must also be • Satisfying • Available • Convenient • Economical
7 TM
![Page 6: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/6.jpg)
Problems
• Fortification impact varies by age, sex, physiological group – Not everyone eats fortified food if only one is fortified – People with worst diets often don’t eat fortified foods
• Fortifying several foods may hit more people – but more difficult to assess impact and avoid
excess
• Supplements complicate further
TM
![Page 7: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/7.jpg)
Problems
• Excess
• Technical difficulties
TM
![Page 8: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/8.jpg)
What is the evidence micronutrient fortification/enrichment make a difference in US diets?
10 TM
![Page 9: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/9.jpg)
TM
Fulgoni V., Keast D.,Bailey R and J. Dwyer. Foods, Fortificants, and Supplements: Where Do Americans Get Their Nutrients? J Nutr. 2011 Oct;141(10):1847-54.
![Page 10: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/10.jpg)
TM
Data Development
• ILSI North America’s Fortification Committee initiated and funded the development of data
• Data development and analysis conducted by Nutrition Impact, LLC by D.Keast, V. Fulgoni
• ILSI NA Science Advisor-Johanna Dwyer, DSC, RD, Gov’t Liaison- Regan Bailey,Ph.D,RD
![Page 11: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/11.jpg)
TM
Methodology • NHANES 03-04 and 05-06 dietary intake data • NCI method to estimate usual intakes • USDA FNDDS 2.0 and 3.0 and standard release 18 and
20 used for 03-04 and 05-06 food composition data, respectively*
• Database created to separate the amount of intrinsic and added nutrients found in each food (included voluntary according to FDA standards for added B 1, B2 niacin, iron, A, folic D and discretionary (nutrient additions other than those defined by FDA for enriched/fortified foods)
![Page 12: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/12.jpg)
TM
< EAR
• The lower the % of people under the Estimated Average Requirement (EAR), the greater the chances they are meeting their nutrient needs
(lower % is better dietary status)
15
![Page 13: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/13.jpg)
74
100 93
88
46 45
93 91
11
37 34
70
60
8
25
0
20
40
60
80
100
120
Vitamin A Vitamin D Vitamin E Folate Vitamin C
Naturally occuringEnrichiched/FortifiedTotal (Foods + Supplements)
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+ y: NHANES 2003-2006
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
![Page 14: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/14.jpg)
51
9 11
22
6 6 2 1.7
12
3 4 1.6 1.2
8
2 0
10
20
30
40
50
60
Thiamin Riboflavin Niacin Vitamin B-6 Vitamin B-12
Naturally occuring
Enrichiched/Fortified
Total (Foods + Supplements)
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
![Page 15: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/15.jpg)
TM
Summary • Major sources of most water soluble vitamins
were enriched/fortified foods and/or supplements
![Page 16: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/16.jpg)
59
22
15
55
7 11
45
5 8
0
10
20
30
40
50
60
70
Magnesium Iron Zinc
Naturally occuring
Enrichiched/Fortified
Total (Foods + Supplements)
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
![Page 17: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/17.jpg)
TM
Summary
• Major sources of most minerals (except for iron) were naturally occurring, intrinsic to foods
![Page 18: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/18.jpg)
TM
Summary Fortification/Enrichment • Fortification/enrichment important in
increasing the % of population >EAR for • vitamins A (from 74 to 45% <EAR) • thiamin (from 51 to 6% <EAR) • folate (from 88 to 11% <EAR) • iron (from 22 to 7% <EAR)
• They also helped to increase nutrient adequacy for B-2, B-6, niacin, B-12, C, D
![Page 19: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/19.jpg)
TM
Summary
•Few exceeded the UL •But these measures didn’t eliminate need to increase intakes of 2010 nutrients of concern:
•D 93% still <EAR with added nutrients, 70% with supplements •Calcium •Potassium •Fiber (analyses coming via Dr. D. Gee (ODS/NIH)
![Page 20: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/20.jpg)
TM
Caution • With enrichment/fortification, increases may
be greater for some age/sex groups than others, depending on foods consumed by each age/sex group
• Dr. Louise Berner is completing this analysis now on children
• Analysis did not separate out different types of voluntary fortification
• Dietary inadequacy/excess is not same as nutritional status
![Page 21: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/21.jpg)
TM
• Supplements increased the % of the population meeting the EAR – especially for nutrients that are not
prevalent in foods (vitamins D and E)
• Supplements also increased the % > UL
What about supplements?
![Page 22: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/22.jpg)
TM
Summary
• Gains in preventing dietary inadequacy were
less with supplements (on a total population basis)
• Separate analyses of supplement users and nonusers told a different story (Bailey et al) • many did not take micronutrient-containing
supplements • those who did take supplements weren’t always
those who needed nutrients in question
![Page 23: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/23.jpg)
TM
Bottom Line • With all sources of micronutrients included,
most Americans met recommended nutrient targets for the majority (but not all) of vitamins and minerals evaluated
• However….. – far fewer individuals would have done so without
intakes of enriched and fortified foods – and even fewer if dietary supplements were
excluded
![Page 24: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/24.jpg)
TM
Micronutrients of Concern
• What did fortification and enrichment contribute to US intakes today to increasing intakes of “nutrients of concern” as identified by the Dietary Guidelines 2010?
27
![Page 25: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/25.jpg)
TM
What is a micronutrient of concern??
“One falling short of recommended intake levels for substantial percentage of US citizens” Clear public health need for more of these micronutrients by many Americans -For others already plentiful in diets,
public health rationale not so strong
29
![Page 26: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/26.jpg)
Nutrients of Concern for Americans to Increase Dietary Guidelines for Americans 2010
• Vitamin D
• Calcium
• Potassium
• Fiber
30 TM
![Page 27: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/27.jpg)
TM
Nutrients of concern 2010
FIBER Vitamin D
CALCIUM
POTASSIUM
32
![Page 28: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/28.jpg)
Vitamin D: Some intrinsic in food, not a lot
33 TM
![Page 29: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/29.jpg)
34
![Page 30: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/30.jpg)
Vitamin D: Cod and Menhaden liver oil
35 TM
![Page 31: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/31.jpg)
Vitamin D: these fortified foods served us well in the past
36
10microgm/qt
TM
![Page 32: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/32.jpg)
Vitamin D: other fortified foods didn’t
37
Beer
Hot Dogs
Soft drinks
TM
![Page 33: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/33.jpg)
100 93
70
0
20
40
60
80
100
120
Vitamin D
Naturally occuringEnrichiched/FortifiedTotal (Foods + Supplements)
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+ y: NHANES 2003-2006
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
![Page 34: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/34.jpg)
Even with fortification, 70% still below EAR for D
![Page 35: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/35.jpg)
54
49
38
0
10
20
30
40
50
60
Calcium
Naturally occuring
Enrichiched/Fortified
Total (Foods + Supplements)
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
![Page 36: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/36.jpg)
Foods for increasing micronutrient intakes must reach high risk target groups Old strategies focused on dairy don’t reach some target groups (teen girls, older women) in some countries (Finland, Jordan, India, US)
41
Don’t reach these groups
TM
![Page 37: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/37.jpg)
D is Ireland’s “other” problem
• D Fortification sporadic – Mandatory D in fat spreads and cooking
oils – Voluntary in all others but not widespread
or at uniform levels
• Problem – D deficiency common – Main dietary sources of D are fish, dairy,
egg yolk, mushroom, meat and fish
TM
![Page 38: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/38.jpg)
Micronutrient rich foods must reach high risk target groups
• Encourage naturally high calcium foods? • New strategies needed?
– More/higher voluntary fortification of dairy? – Fortified RTE and hot cereals – Calcium fortified orange juice – Bread fortified with Calcium – Fortified soymilk & meal replacements – Mushrooms irradiated to produce D?
43 TM
![Page 39: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/39.jpg)
Don’t overdo it! D and Post WW II UK • Margarine D fortified & many gave
cod liver oil to infants and children – Overfortified baby milk products with D, with
other sources of D caused D intoxication in infants, metastatic calcification soft tissues,etc
• Result: ban on fortified milk products in many European countries
-continued skittishness on D fortification
TM
![Page 40: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/40.jpg)
Potassium Problem
• Increase intake of foods rich in it • Fortify?? (not easy) • Make new foods high in potassium (not easy) • Supplements? (horse sized pills)
TM
![Page 41: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/41.jpg)
> AI
• The greater the % of population over the Adequate Intake (AI), the more likely chances are their dietary status is good
![Page 42: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/42.jpg)
2.2
2.4
2.5
2.05
2.1
2.15
2.2
2.25
2.3
2.35
2.4
2.45
2.5
2.55
Potassium
Naturally occuring
Enrichiched/Fortified
Total (Foods + Supplements)
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes OVER >AI by source in Americans, ages 2+y POTASSIUM
![Page 43: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/43.jpg)
TM
Fiber not considered today
• Fiber- analysis in progress Dr. David Gee
• Major problem in US diets
48
![Page 44: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/44.jpg)
TM
Nutrients of Concern in Dietary Guidelines for Americans 2005 • Adults:
– Vitamin A (as carotenoids) – Vitamin C – Magnesium – Calcium – Vitamin E – Fiber – Potassium
• Children – Calcium – Magnesium – Vitamin E – Potassium
49
![Page 45: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/45.jpg)
59 55
45
0
10
20
30
40
50
60
70
Magnesium
Naturally occuring
Enrichiched/Fortified
Total (Foods + Supplements)
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
![Page 46: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/46.jpg)
74
93
46 45
91
37 34
60
25
0
10
20
30
40
50
60
70
80
90
100
Vitamin A Vitamin E Vitamin C
Naturally occuringEnrichiched/FortifiedTotal (Foods + Supplements)
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+ y: NHANES 2003-2006
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
![Page 47: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/47.jpg)
TM
Not considered today–
• Vitamin C (possible subgroup inadequacy?)
• Iron (problematic: toxicity & deficiency)
55
![Page 48: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/48.jpg)
59
22
15
54 55
7 11
49 45
5 8
38
0
10
20
30
40
50
60
70
Magnesium Iron Zinc Calcium
Naturally occuring
Enrichiched/Fortified
Total (Foods + Supplements)
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
![Page 49: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/49.jpg)
TM
Other Nutrients of Interest
Folic Acid
57
![Page 50: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/50.jpg)
Folate: Naturally occurring food sources
58 TM
![Page 51: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/51.jpg)
Folate: fortified food sources
59
Whole Grains & Masa flour soon?
TM
![Page 52: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/52.jpg)
88
11 8
0
10
20
30
40
50
60
70
80
90
100
Folate
Naturally occuringEnrichiched/FortifiedTotal (Foods + Supplements)
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+ y: NHANES 2003-2006
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
![Page 53: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/53.jpg)
Trends in serum folate before and after folic acid fortification, USA
0
10
20
30
40
50
60
0 5 10 15 20 25 30 35 40
Serum folate (ng/mL)
Perc
ent (
%)
1988-1994 1999-2000 2001-2002 2003-2004
3 ng/mL serum folate
![Page 54: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/54.jpg)
TM
Colon cancer pre and post-folic acid fortification: Age-adjusted incidence - United States & Canada
![Page 55: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/55.jpg)
Risk-Risk
400 – 800 mcg??? 1000 - ????? mcg???
deficiency excess
TM
![Page 56: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/56.jpg)
TM
Other Nutrients of Interest
Vitamin K (problematic since an anticoagulant)
64
![Page 57: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/57.jpg)
30.1 31.1
45
0
5
10
15
20
25
30
35
40
45
50
Vitamin K
Naturally occuring
Enrichiched/Fortified
Total (Foods + Supplements)
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
Prevalence (%) of Intakes OVER > AI by source in Americans, ages 2+y : Vitamin K
![Page 58: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/58.jpg)
TM
Not considered today – public health problems unlikely
• B vitamins (little evidence inadequacy)
• Zinc (no biomarker)
66
![Page 59: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/59.jpg)
51
9 11
22
6 6 2 1.7
12
3 4 1.6 1.2
8
2 0
10
20
30
40
50
60
Thiamin Riboflavin Niacin Vitamin B-6 Vitamin B-12
Naturally occuring
Enrichiched/Fortified
Total (Foods + Supplements)
Prevalence (%) of Intakes < EAR by source in Americans, ages 2+y
Fulgoni VL, Keast DR, Bailey RL, Dwyer J. Journal of Nutrition, 2011;141(10)L1805-12
![Page 60: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/60.jpg)
TM
• Fortification and enrichment don’t solve
all micronutrient adequacy problems
• Monitoring needed to identify and guard against excess of some micronutrients
Summary
![Page 61: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/61.jpg)
TM
Next Steps for Nutrition Science • Importance of NHANES and other
population based surveys for monitoring, surveillance, modeling – What do you do without such a survey?
• Who is getting too much, too little?
– Biomarkers of intake, excess
69
![Page 62: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/62.jpg)
TM
Next Steps for Nutrition Science • Best models for UL
• Guidelines for fortification :
– USA, Canada, Denmark, AFSSA, EFSA?
• Best ways to label
• Best links to health claims
70
![Page 63: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/63.jpg)
TM
Next Steps for Food Science
71
![Page 64: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/64.jpg)
72
![Page 65: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/65.jpg)
TM
Next Steps for Food Technology
• Technologies for increasing potassium in the diet without spoiling taste
• Find strategies for increasing adequacy of diets in vitamin D without exceeding upper safe levels
73
![Page 66: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/66.jpg)
TM
Next Steps for Food Technology
• More bioavailable forms of minerals Americans fall short in? (Calcium,, potassium, possibly Mg)?
• Palatable sources of dietary fiber?
• Technical problems: matrices, etc.
74
![Page 67: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/67.jpg)
TM
Next Steps for Food Technology
• Are fortified foods less” healthy” than non-fortified foods (because of more calories, sugar, fat, or salt in them?)
• What should ground rules be for adding non-nutrient bioactives?
75
![Page 68: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/68.jpg)
Fortification Futures? • Iodine
– Processed foods? – Supplements (prenatal)? – Today adventitious I in milk major source
• Folate in masa flour?
• Other strategies?
TM
![Page 69: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/69.jpg)
TM
Strategies for remaining problem micronutrients
• Food based Dietary Guidelines? • Fortify?
– Few foods at higher levels? • But risk of overdose higher • Usual US strategy
– Many foods at lower levels • Hits non-consumers of some foods • More difficult to monitor
• Supplement?
78
![Page 70: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/70.jpg)
TM
Fortification Future
• Rifles, not shotguns needed
• “Pixie dust” marketing (fortification of small amounts of nutrients already plentiful in diets) – not a public health measure
![Page 71: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/71.jpg)
TM
Keep amounts reasonable
• Consider total micronutrient intake, from all foods, not just a single product – Consider standardizing within product categories for voluntary efforts
• More is not always better
– Supplement users may get too much
![Page 72: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/72.jpg)
Consumer perception and professional backlash likely with fortification of foods high in fat, sugar, or salt
• Remember SmartChoice!
81 TM
![Page 73: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/73.jpg)
TM
Stay tuned on labeling
Reconsider formulations when and if Nutrient Facts & Supplement Facts panels updated (EAR,RDA disputes)
Child dietary supplement formulations?
![Page 74: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/74.jpg)
TM
Take home
• Fortification and enrichment help Americans meet recommended nutrient targets for most (but not all) of vitamins and minerals of concern, and others we evaluated
![Page 75: Micronutrient enrichment & fortification make a …ilsina.org/wp-content/uploads/sites/6/2016/06/5_JDwyer_June-2012.pdf · Micronutrient enrichment & fortification make a difference](https://reader031.vdocuments.mx/reader031/viewer/2022022009/5af5d6eb7f8b9a9e598e965d/html5/thumbnails/75.jpg)
TM
Thank you!
84