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Background Food insecurity is associated with poorer nutrient intakes from food sources and lower dietary supplement use. However, its association with total usual nutrient intakes, inclusive of dietary supplements, and biomarkers of nutritional status among US children remains unknown. Objective The objective was to assess total usual nutrient intakes, Healthy Eating Index-2015 (HEI-2015) scores, and nutritional biomarkers by food security status, sex, and age among US children. Methods Cross-sectional data from 9147 children aged 1-18 y from the 2011-2016 NHANES were analyzed. Usual energy and total nutrient intakes and HEI-2015 scores were estimated using the National Cancer Institute method from 24-h dietary recalls. Results Overall diet quality was poor, and intakes of sodium, added sugars, and saturated fat were higher than recommended limits, regardless of food security status. Food-insecure girls and boys were at higher risk of inadequate intakes for vitamin D and magnesium, and girls also had higher risk for inadequate calcium intakes compared with their food-secure counterparts, when total intakes were examined. Choline intakes of food-insecure children were less likely to meet the adequate intake than those of their food-secure peers. No differences by food security status were noted for folate, vitamin C, iron, zinc, potassium, and sodium intakes. Food-insecure adolescent girls aged 14-18 y were at higher risk of micronutrient inadequacies than any other subgroup, with 92.8% (SE: 3.6%) at risk of inadequate intakes for vitamin D. No differences in biomarkers for vitamin D, folate, iron, and zinc were observed by food security status. The prevalence of iron deficiency was 12.7% in food-secure and 12.0% in food-insecure adolescent girls. Conclusions Food insecurity was associated with compromised intake of some micronutrients, especially among adolescent girls. These results highlight a need for targeted interventions to improve children's overall diet quality, including the reduction of specific nutrient inadequacies, especially among food-insecure children. This study was registered at clinicaltrials.gov as NCT03400436.

Objective:To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight.Design:Cross-sectional study.Setting:Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011–2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score.Participants:Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size.Results:A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression.Conclusions:Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.

BACKGROUND: Accurate and reliable methods to assess prevalence of use of and nutrient intakes from dietary supplements (DSs) are critical for research, clinical practice, and public health monitoring. NHANES has been the primary source of DS usage patterns using an in-home inventory with a frequency-based DS and Prescription Medicine Questionnaire (DSMQ), but little is known regarding DS information obtained from 24-h dietary recalls (24HRs). METHODS: The objectives of this analysis were to compare results from 4 different methods for measuring DS use constructed from two data collection instruments (i.e., DSMQ and 24HR) and to determine the most comprehensive method for measuring the prevalence of use and estimating nutrient intakes from DS for selected nutrients. NHANES 2011–2014 data from US adults (aged ≥19 y; n = 11,451) were used to examine the 4 combinations of methods constructed for measuring the prevalence of use of and amount of selected nutrients from DSs (i.e., riboflavin, vitamin D, folate, magnesium, calcium): 1) DSMQ, 2) 24HR day 1, 3) two 24HRs (i.e., mean), and 4) DSMQ or at least one 24HR. RESULTS: Half of US adults reported DS use on the DSMQ (52%) and on two 24HRs (mean of 49%), as compared with a lower prevalence of DS use when using a single 24HR (43%) and a higher (57%) prevalence when combining the DSMQ with at least one 24HR. Mean nutrient intake estimates were highest using 24HR day 1. Mean supplemental calcium from the DSMQ or at least one 24HR was 372 mg/d, but 464 mg/d on the 24HR only. For vitamin D, the estimated intakes per consumption day were higher on the DSMQ (46 μg) and the DSMQ or at least one 24HR (44 μg) than those on the 24HR day 1 (32 μg) or the mean 24HR (31 μg). Fewer products were also classed as a default or reasonable match on the DSMQ than on the 24HR. CONCLUSIONS: A higher prevalence of use of DSs is obtained using frequency-based methods, whereas higher amounts of nutrients are reported from a 24HR. The home inventory results in greater accuracy for products reported. Collectively, these findings suggest that combining the DSMQ with at least one 24HR (i.e., DSMQ or at least one 24HR) is the most comprehensive method for assessing the prevalence of and estimating usual intake from DSs in US adults. This trial was registered at clinicaltrials.gov as NCT03400436.

BACKGROUND: Sarcopenia, a progressive loss of skeletal muscle mass and strength, can begin in the 4th decade of life. Protein intake predicts skeletal muscle mass and strength among older adults, but knowledge of similar associations among middle-aged adults is lacking. OBJECTIVES: We aimed to assess associations between protein intake and skeletal muscle mass, characterized by appendicular lean mass adjusted for BMI [in kg/m(2) (ALM(BMI))], and muscle strength, represented by handgrip strength adjusted for BMI (GSMAX(BMI)), among middle-aged adults. METHODS: We analyzed cross-sectional data from 1209 men and 1208 women aged 40–59 y in the 2011–2014 NHANES. Protein intake per kilogram actual body weight (BW), assessed by two 24-h recalls, was examined as continuous and categorical parameters [low (

OBJECTIVES: Policy proposals to limit use of the Supplemental Nutrition Assistance Program (SNAP) and to allow dietary supplement (DS) purchase with SNAP benefits draw attention to knowledge gap of usual nutrient intake and adherence to the Dietary Reference Intake recommendations from foods alone and with DS (total intake) among low-income older adults. To address this gap, the estimated distributions of usual nutrient intake (from foods alone and total) and risk of inadequate intake among U.S. older adults participating in SNAP were compared with income-eligible non-participants. METHODS: Data from 4,791 older adults (≥60 years) from the 2007–2016 National Health and Nutrition Examination Survey were used in this cross-sectional secondary analysis. DS data from an in-home inventory and dietary data from up to two 24-hour recalls were used to estimate usual nutrient intake distributions (total and from foods alone) and the proportion of the population below the Estimated Average Requirement (EAR) using an adapted National Cancer Institute method. Pairwise t-tests compared SNAP participants and eligible non-participants with significance set at P

A priori dietary indices provide a standardized, reproducible way to evaluate adherence to dietary recommendations across different populations. Existing nutrient-based indices were developed to reflect food/beverage intake; however, given the high prevalence of dietary supplement (DS) use and its potentially large contribution to nutrient intakes for those that use them, exposure classification without accounting for DS is incomplete. The purpose of this article is to review existing nutrient-based indices and describe the development of the Total Nutrient Index (TNI), an index developed to capture usual intakes from all sources of under-consumed micronutrients among the U.S. population. The TNI assesses U.S. adults' total nutrient intakes relative to recommended nutrient standards for eight under-consumed micronutrients identified by the Dietary Guidelines for Americans: calcium, magnesium, potassium, choline, and vitamins A, C, D, E. The TNI is scored from 0 to 100 (truncated at 100). The mean TNI score of U.S. adults (≥19 y; n = 9,954) based on dietary data from NHANES 2011-2014, was 75.4; the mean score for the index ignoring DS contributions was only 69.0 (t-test; p < 0.001). The TNI extends existing measures of diet quality by including nutrient intakes from all sources and was developed for research, monitoring, and policy purposes.

OBJECTIVES To characterize dietary supplement use among US children, including product type, motivations, user characteristics, and trends over time with a primary focus on non-vitamin/non-mineral dietary supplements (NVNM). STUDY DESIGN Overall, NVNM, and vitamin and/or mineral dietary supplement only (VM-only) use; motivations for use; and trends in use over time were examined in children (≤19 years of age) using the National Health and Nutrition Examination Survey 1999-2016 data (n = 42 510). RESULTS Between 1999 and 2016, overall dietary supplement and VM-only dietary supplement use among all children remained relatively stable at ∼30%; yet, NVNM dietary supplement use increased from 2.9% to 6.4%, mainly due to increased use of omega-3 polyunsaturated fatty acids. NVNM use was greater in boys than in girls (3.9% vs 3.3%), and greater in older children than in younger children (Ptrend

This study examined total usual micronutrient intakes from foods, beverages, and dietary supplements (DS) compared to the Dietary Reference Intakes among U.S. adults (&ge, 19 years) by sex and food security status using NHANES 2011&ndash, 2014 data (n = 9954). DS data were collected via an in-home interview, the NCI method was used to estimate distributions of total usual intakes from two 24 h recalls for food and beverages, after which DS were added. Food security status was categorized using the USDA Household Food Security Survey Module. Adults living in food insecure households had a higher prevalence of risk of inadequacy among both men and women for magnesium, potassium, vitamins A, B6, B12, C, D, E, and K, similar findings were apparent for phosphorous, selenium, and zinc in men alone. Meanwhile, no differences in the prevalence of risk for inadequacy were observed for calcium, iron (examined in men only), choline, or folate by food security status. Some DS users, especially food secure adults, had total usual intakes that exceeded the Tolerable Upper Intake Level (UL) for folic acid, vitamin D, calcium, and iron. In conclusion, while DS can be helpful in meeting nutrient requirements for adults for some micronutrients, potential excess may also be of concern for certain micronutrients among supplement users. In general, food insecure adults have higher risk for micronutrient inadequacy than food secure adults.

OBJECTIVES: To estimate total mean usual micronutrient intakes (inclusive of dietary supplements (DS)), Dietary Reference Intakes (DRI) adherence, and the % contribution of DS to total usual micronutrient intakes for U.S. adults (≥19y) using data from the 2011–2014 National Health and Nutrition Examination Survey (NHANES, n = 9474), by sex, age, and race and Hispanic origin groupings. METHODS: Dietary data were collected using two 24-hour recalls; DS data was collected via an in-home 30-day questionnaire that ascertained participants’ usage in the past 30 days. The National Cancer Institute Method was used to estimate mean total usual micronutrient intakes and the proportion of the population complying with DRI by population subgroups: sex, age, and race and Hispanic origin. RESULTS: DS contributed substantially to meeting the DRI recommendations for several key nutrients, including calcium, magnesium, folate, zinc, and vitamins C, D, B6, and K in both men and women. However, approximately half of U.S. adults still failed to meet the estimated average requirement (EAR) for magnesium (45%), and vitamins C (35%), K (45%), and D (63%), even with the inclusion of DS. The proportion of total usual intakes

OBJECTIVES: Little is known whether the prevalence of dietary supplement (DS) use among children varies by assessment method as it does among adults. We assessed the prevalence of use of different DS product types among U.S. children using four different combinations of assessment methods constructed from two instruments (i.e., frequency-based questionnaire and 24-hour dietary recall (24HR)). METHODS: DS use information is collected in the National Health and Nutrition Examination Survey (NHANES) via a 30-day frequency questionnaire in conjunction with an in-home inventory (Dietary Supplement and Prescription Medicine, DSMQ) and during up to two 24HR. NHANES 2013–2016 data were used to estimate the prevalence of use of any DS and selected types of DS products among 8369 children (≤18y) using four methods constructed from DSMQ and 24HR: 1) DSMQ; 2) 24HR day 1; 3) 24HR day 1 and day 2; and 4) DSMQ and ≥1 24HR. RESULTS: About one-third (34.4%) of children took at least one DS in the previous 30 days according to the DSMQ. This decreased to 21.0% when data from only the 24HR day 1 were used, increased to 26.2% when data from both the 24HR day 1 and day 2 were used, and increased further to 37.3% when data from the DSMQ and ≥1 24HR were combined. Similar patterns were found when stratified by age (

OBJECTIVES: To estimate distributions of total usual vitamin D intakes from foods and supplements among U.S. adults, using four different methods of assessment. Usual intake is defined as long-term average daily intake. METHODS: Distributions of total usual vitamin D intakes were estimated from data provided by 9954 adults (≥19 y) from the 2011–2014 NHANES. Dietary and dietary supplement (DS) data were collected using two 24-hour recalls (24HR), and DS data were also collected via an in-home inventory that ascertained participants’ DS use in the past 30 days. The four methods used included: combined “add then shrink” (Method 1); combined “shrink then add” (Method 2); stratified “shrink then add” (Method 3); three-part (Method 4). Briefly, Method 1 analyzes DS users and nonusers together and includes DS use as a covariate in the model. Nutrient intake from foods and DS are “added” prior to applying usual intake procedures to “shrink” the total intake distribution. Method 2 combines DS users and nonusers identically, but “shrinks” the nutrient intake distribution from foods prior to incorporating nutrient intake from DS to produce total usual intakes. Method 3 also follows the “shrink then add” framework but stratifies DS users and nonusers separately in the model. Method 4 also stratifies DS users and nonusers but computes total usual intakes in three parts: 1) usual intake from foods for DS nonusers; 2) usual intake from foods for DS users; and 3) usual intake from DS for DS users. RESULTS: All methods following the “shrink then add” framework (i.e., methods 2- 4) resulted in similar estimated distributions of total usual vitamin D intakes; but Method 1, the “add then shrink” method, resulted in distributions that were wider as a result of inflated within-person variation. Among the “shrink then add” methods, the main differences existed between methods 2 and 3 vs. method 4, partly due to differences in modeling of DS intake information reported on 24HRs vs. the in-home inventory. CONCLUSIONS: Currently, no consensus exists on the best method for incorporating DS nutrients into usual intake models designed to estimate intake from foods and beverages. These findings support the notion that the “shrink then add” methods are more amenable to modeling when compared to “add then shrink.” FUNDING SOURCES: This work was supported by a grant from the National Institutes of Health.

This analysis characterizes use of dietary supplements (DS) and motivations for DS use among U.S. children (&le, 18 years) by family income level, food security status, and federal nutrition assistance program participation using the 2011&ndash, 2014 National Health and Nutrition Examination Survey data. About one-third (32%) of children used DS, mostly multivitamin-minerals (MVM, 24%). DS and MVM use were associated with higher family income and higher household food security level. DS use was lowest among children in households participating in the Supplemental Nutrition Assistance Program (SNAP, 20%) and those participating in the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC, 26%) compared to both income-eligible and income-ineligible nonparticipants. Most children who used DS took only one (83%) or two (12%) products, although children in low-income families took fewer products than those in higher income families. The most common motivations for DS and MVM use were to &ldquo, improve (42% or 46%)&rdquo, or &ldquo, maintain (34 or 38%)&rdquo, health, followed by &ldquo, to supplement the diet (23 or 24%)&rdquo, for DS or MVM, respectively. High-income children were more likely to use DS and MVM &ldquo, to supplement the diet&rdquo, than middle- or low-income children. Only 18% of child DS users took DS based on a health practitioner&rsquo, s recommendation. In conclusion, DS use was lower among children who were in low-income or food-insecure families, or families participating in nutrition assistance programs.

The objective of this study was to estimate the prevalence of use and types of dietary supplements (DS) used by U.S. adults (&ge, 19 years) by sociodemographic characteristics: family income-to-poverty ratio (PIR), food security status, and Supplemental Nutrition Assistance Program (SNAP) participation using NHANES 2011&ndash, 2014 data (n = 11,024). DS use was ascertained via a home inventory and a retrospective 30-day questionnaire. Demographic and socioeconomic differences related to DS use were evaluated using a univariate t statistic. Half of U.S. adults (52%) took at least one DS during a 30-day period, multivitamin-mineral (MVM) products were the most commonly used (31%). DS and MVM use was significantly higher among those with a household income of &ge, 350% of the poverty level, those who were food secure, and SNAP income-ineligible nonparticipants across all sex, age, and race/ethnic groups. Among women, prevalence of use significantly differed between SNAP participants (39%) and SNAP income-eligible nonparticipants (54%). Older adults (71+ years) remained the highest consumers of DS, specifically among the highest income group (82%), while younger adults (19&ndash, 30 years), predominantly in the lowest income group (28%), were the lowest consumers. Among U.S. adults, DS use and the types of products consumed varied with income, food security, and SNAP participation.

Background Given the current prevalence of both cigarette use and obesity in the United States, identification of dietary patterns that reduce mortality risk are important public health priorities. The objective of the present study was to evaluate the correlation between cigarette use and dietary energy density, a marker for diet quality, in a population of current smokers, former smokers, and never smokers. Methods Data from a nationally representative sample of 5293 adults who participated in the 2013–2014 National Health and Nutrition Examination Surveys (NHANES) were analyzed. Specific survey procedures were used in the analysis to account for sample weights, unequal selection probability, and clustered design when evaluating the association between dietary energy density (ED, energy per weight of food, kcal/g) and current smoking status. Never smokers reported 100 lifetime cigarettes and current smoking status was recorded as daily, some days (nondaily), or not at all (former). Results A strong linear relationship was observed between smoking pattern and dietary ED in current smokers. Compared to never smokers, daily smokers and nondaily smokers have significantly higher dietary ED (1.79 vs. 2.02 and 1.88, respectively; both p

Background: Nutrition is critical to HIV mortality and morbidity. Improved treatment modalities have increased life expectancy of HIV-infected individuals. More than 1 million US adults are living with HIV, but little is known about their nutritional status. Objective: We aimed to characterize the nutritional status of those living with HIV with the use of the NHANES 2003–2014. Methods: The NHANES is a nationally representative, cross-sectional survey of the US population and includes a household interview, medical examination, and two 24-h dietary recalls; survey weights are applied to make the data nationally representative. HIV antibodies were ascertained initially by immunoassay and confirmed with Western blot. NHANES 2003–2014 data were analyzed for HIV-positive (n = 87) and HIV-negative (n = 15,868) US adults (aged 19–49 y). Body mass index (BMI), waist circumference, dietary intakes, and nutritional biomarkers were estimated and compared by HIV status, stratified by sex. Results: HIV-infected men and women had higher serum protein, lower serum albumin, and lower serum folate than did non–HIV-infected adults. HIV-positive women had significantly higher BMI, prevalence of overweight or obesity, and waist circumference risk and substantially lower serum 25-hydroxyvitamin D concentrations (44 compared with 65 nmol/L) than did HIV-negative women. When compared with HIV-negative women, HIV-positive women had lower intakes of some key nutrients such as fiber, vitamin E, vitamin K, magnesium, and potassium but had higher intakes of protein and niacin. Conclusions: The NHANES data suggest that HIV infection is associated with poorer markers of some nutritional status indicators; however, the US population prevalence of HIV is

OBJECTIVES: The purpose was to evaluate nutritional status, food security, and related health factors of older adults who were overweight or obese compared to those with a healthy weight. METHODS: Data from 2969 adults aged ≥60 years from NHANES 2011–2014 were analyzed. Participants were categorized by sex and body weight status as healthy weight (body mass index (BMI, kg/m(2)) 18.5–24.9), overweight (BMI 25–29.9), or obese (BMI ≥ 30); underweight individuals were excluded. Healthy Eating Index (HEI)-2015 scores and total usual micronutrient intakes from foods and dietary supplements were estimated using two 24-hour dietary recalls and the National Cancer Institute method. Nutritional biomarkers, including serum vitamin D, vitamin B-12, and methylmalonic acid, and cardiometabolic risk factors were also assessed. RESULTS: A substantial proportion of older adults (>30%) had intakes below Estimated Average Requirements (EAR) for calcium, magnesium, and vitamins C and D even with dietary supplements. Men and women with obesity had a higher prevalence of usual magnesium intakes

OBJECTIVES: The purpose of this analysis was to compare the association between adult snacking frequency and weight status and central adiposity across various definitions of a snack. Specifically, we investigated whether the definition of a snack alters the odds ratio (OR) of having overweight or obesity (OW/OB, BMI ≥ 25 kg/m(2)) by consumption frequency and the contribution to total daily energy intake. In addition, we compared the OR of waist circumference risk (WC ≥ 102 men; 88 cm women) and sagittal abdominal diameter risk (SAD ≥ 25 men and 24 cm women) with snacking frequency and contribution to total daily energy using three common snack definitions. METHODS: Anthropometric measurements, one 24HR dietary recall, and demographic information (sex, age, race and Hispanic origin, income, and smoking status) from U.S. adults (≥20y; n = 20,146) collected during NHANES 2013–2016 were used in this analysis. Snacking events were defined by one of three definitions: 1) events defined by the reporter as a “snack,” 2) any event outside of a typical meal time (i.e., breakfast, lunch, dinner, super, brunch), or 3) ingestion events that contribute

High intake of added sugars is associated with excess energy intake and poorer diet quality. The objective of this cross-sectional study (n = 16,806) was to estimate usual intakes and the primary food sources of added sugars across the range of intakes (i.e., deciles) among U.S. children (2–8 years), adolescents and teens (9–18 years), and adults (≥19 years) using the National Health and Nutrition Examination (NHANES) data from 2009–2012. The percent energy contributed by added sugars was 14.3 ± 0.2% (2–8 years), 16.2 ± 0.2% (9–18 years), and 13.1 ± 0.2% (≥19 years), suggesting the highest intakes are among adolescents and teens. However, the primary foods/beverages that contribute to added sugars were remarkably consistent across the range of intakes, with the exception of the lowest decile, and include sweetened beverages and sweet bakery products. Interestingly across all age groups, even those in the lowest decile of added sugars exceed the 10% guidelines. Additional foods contributing to high intakes were candy and other desserts (e.g., ice cream) in children and adolescents, and coffee and teas in adults. Tailoring public health messaging to reduce intakes of these identified food groups may be of utility in designing effective strategies to reduce added sugar intake in the U.S.