Vitamin B6 also gets added to breakfast foods, power bars, and powders. The body does not store vitamin B6, so it's important to eat foods that contain it every day in order to not develop a deficiency. People with kidney disease or those who have a condition that hinders food absorption by the small intestine are at risk of lacking the vitamin. Iron is a crucial mineral that is found in every cell of the body. The body needs it to make the oxygen-carrying proteins hemoglobin, which is found in red blood cells, and myoglobin, which is found in muscles.
Iron deficiency is most prevalent among young children and women of childbearing age and pregnant women, according to the CDC, and can cause developmental delays in children and preterm delivery in pregnant women. Iron deficiency results in anemia, a condition in which blood lacks adequate healthy red blood cells.
Mild anemia often goes undiagnosed for a long time, but as it becomes more severe symptoms include fatigue, pale skin or brittle nails, and headaches. Treatment varies depending on the severity and often involves taking iron supplements.
Some foods that are rich in iron include liver, oysters, red meat, sardines, spinach, broccoli, and some fortified foods. Vitamin D is crucial for bone health. People who don't have enough of it are at higher risk of bone density loss, which increases the risk of osteoporosis and bone fractures.
People who are more likely to lack vitamin D are breastfed infants, older people, people with darker skin, and people with certain conditions such as kidney or liver disease.
The body does not make vitamin D and can only get it from the sun, foods, or supplements. Good food sources of vitamin D include salmon, trout, swordfish, eggs, mushrooms, and some fortified foods such as milk. Iodine is crucial for the production of thyroid hormone, which is essential to many body processes such as regulating calorie burn, affecting heartbeat and body temperature, controlling skin turnover and brain health. The body cannot make iodine and can only get it through food or supplements.
Common food sources of iodine include cheese, cow's milk, eggs, iodized salt, and soy milk. People with the highest risk of lacking enough iodine in their blood are those living in areas where the soil is iodine deficient because it produces crops with low iodine levels.
Such places include mountainous areas and river valleys prone to flooding. High-potassium diets have been associated with a lower risk of stroke , hypertension , osteoporosis , and kidney stones for more information, see the article on Potassium.
Several foods are listed in Table 3 , along with their potassium content in milligrams. Any diet that eliminates entire food groups has the potential for being inadequate in several micronutrients.
Those who adhere to a vegan diet, which excludes all foods of animal origin, are at increased risk for select micronutrient deficiencies and inadequacies, especially vitamin B 12 , but also vitamin D, calcium, and potentially iodine, iron, and zinc.
Vegetarians who consume dairy and eggs may also be at a heightened risk of certain micronutrient inadequacies, particularly iron and zinc. Because vitamin B 12 is found only in foods of animal origin, a vegan diet will result in vitamin B 12 deficiency — and devastating neurologic consequences — unless there is intake from fortified food or supplements.
Few plant-source foods, including certain fermented beans and vegetables and edible algae and mushrooms, may contain substantial amounts of vitamin B 12 Together with B-vitamin fortified food and supplements, these foods may contribute, although modestly, to prevent vitamin B 12 deficiency in individuals consuming vegetarian or vegan diets.
Another large cohort in the US and Canada, the Adventist Health Study 2, assessed nutrient intake among more than 71, participants of which 5, were vegans This study found an average daily intake of 6. Adequate status of vitamin D is needed for optimal bone health. Other studies have found that intake of calcium — another nutrient essential for bone health — is a concern for vegans 60, While dairy is an important source of calcium, some plant foods are good sources of bioavailable calcium.
The calcium in foods of the kale family broccoli, bok choy, cabbage, mustard, and turnip greens is as bioavailable as that found in milk. However, other plant-based foods contain components that inhibit the absorption of calcium. Oxalic acid oxalate is the most potent inhibitor of calcium absorption and is found at high concentrations in spinach and rhubarb and at lower concentrations in sweet potatoes and dried beans.
Phytic acid phytate — found in whole grains , legumes , and cereal 62 — can also inhibit calcium absorption but to a lesser extent than oxalic acid see the article on Calcium. Fortified food can contribute substantially to total daily calcium and vitamin D intake, although the availability of fortified food varies by country. Nutrient intake assessments also differ among studies and can account for variation. Of note, a vegan-specific food frequency questionnaire has recently been developed Limited data also suggest that vegans may be at risk of inadequate iodine intake: A small US cross-sectional study in 63 vegans reported a median urinary iodine concentration of The US population is currently considered to be iodine-sufficient, but vegans and other subpopulations, e.
While vegans and vegetarians may have similar iron and zinc intake compared to omnivores, the bioavailability of these two minerals is lower from plant versus animal sources. Iron from plants, i. Yet, a diet that excludes meat does not appear to be associated with an increased risk of iron deficiency when it includes whole grains, legumes, nuts , seeds, dried fruit, iron-fortified cereal, and green leafy vegetables In a systematic review and meta-analysis of 26 studies, vegetarians had lower dietary intakes and serum zinc concentrations compared to non-vegetarians; a secondary analysis found this association was stronger among vegans However, it is important to note that measuring circulating zinc levels has some limitations e.
Compared to animal sources, zinc bioavailability from plant sources e. The enzymatic action of yeast reduces the level of phytic acid in food 69 , and leavened whole-grain bread therefore has more bioavailable zinc than unleavened whole-grain bread. High levels of dietary calcium impair zinc absorption in animals, but it is uncertain whether this occurs in humans for more information, see the article on Zinc.
Gluten-free grain products are often subject to a milling process that removes the bran and the germ layers of the grain; this refining process strips out fiber and other nutrients.
Moreover, these products may not be enriched or fortified with micronutrients like is typically done with refined wheat products. Gluten-free diets may therefore not supply sufficient amounts of certain vitamins and essential minerals, especially thiamin, riboflavin, niacin, folate, and iron 70, Several micronutrient inadequacies, including folate, vitamin B 12 , vitamin D, calcium, magnesium, iron, and zinc, have been reported in patients treated for Celiac disease , an autoimmune condition that requires avoidance of dietary gluten However, these inadequacies may in part be due to the underlying pathological condition rather than nutritional quality of the diet.
Celiac disease patients are known to display a number of micronutrient deficiencies at the time of diagnosis 73, Diets that exclude iodized salt, fish, and seaweed have been found to contain very little iodine Additionally, certain energy-restricted diets used for weight loss, especially if followed long term, may place individuals at increased risk of micronutrient deficiencies.
One study found that adherence to various weight-loss diets for just eight weeks resulted in a higher prevalence of inadequate micronutrient intakes at eight weeks compared to baseline In particular, micronutrient intake significantly decreased in those who followed the Atkins thiamin, folate, vitamin C, iron, magnesium , LEARN L ifestyle, E xercise, A ttitudes, R elationships, N utrition; thiamin, vitamin E, calcium, magnesium , or Ornish vitamin B 12 , vitamin E, zinc diets Alcoholics are at increased risk for deficiency of several micronutrients, especially vitamin A and the B vitamins.
Chronic alcohol consumption results in depletion of liver stores of vitamin A and may contribute to alcohol-induced liver damage cirrhosis 79, Moreover, the liver toxicity of preformed vitamin A retinol is enhanced by chronic alcohol consumption, thus narrowing the therapeutic window for vitamin A supplementation in alcoholics It is well established that alcoholics are at a heightened risk for inadequate status of many B vitamins, including thiamin, riboflavin, niacin, vitamin B 6 , folate, and vitamin B B vitamins are important in various aspects of energy metabolism in various tissues, including the brain see the article on Cognitive Function ; thus, deficiencies in several B vitamins can cause cognitive disorders.
Wernicke-Korsakoff syndrome WKS , a neuropsychiatric disorder resulting from thiamin deficiency, is common among those who chronically abuse alcohol. Symptoms of WKS include learning deficits, amnesia, eye-movement and gait disorders, disorientation, and confabulation.
Moreover, WKS is one of the more common causes of dementia In alcoholics, general malnutrition, decreased intestinal absorption, impaired phosphorylation of thiamin, and increased urinary excretion may all contribute to thiamin deficiency 82, Administration of intravenous thiamin to WKS patients generally results in prompt improvement of the eye symptoms, but improvements in motor coordination and memory may be less, depending on how long the symptoms have been present and the WKS stage at the time of intervention.
Evidence of increased immune cell activation and increased free radical production in the areas of the brain that are selectively damaged suggests that oxidative stress plays an important role in the neurologic pathology of thiamin deficiency Taken together, alcoholics have an increased requirement for thiamin.
Moreover, alcoholics are at increased risk for riboflavin deficiency due to decreased intake, decreased absorption, and impaired utilization of riboflavin. In rats chronically fed alcohol, the inhibition of riboflavin transporters caused impairment in intestinal absorption and renal re-uptake of the vitamin A combination of low dietary intakes and impaired vitamin metabolism appear to place alcoholics at a higher risk for deficiencies in niacin 86 , vitamin B 6 86 , folate 87 , vitamin B 12 88 , and zinc Exposure to toxins in cigarette smoke causes oxidative damage to indispensable molecules in the body, i.
Along with other cellular antioxidants , vitamins C and E play important roles to protect against the oxidative damage caused by exposure to smoke. Smokers generally have lower vitamin C status than nonsmokers due to increased metabolic turnover and thus require more from their diets Thus, smokers should ensure adequate intake of both vitamins C and E.
Food insecurity i. Some US cross-sectional studies have linked food insecurity with iron-deficiency anemia in young children 97, Additionally, US national surveys NHANES have associated food insecurity with iron-deficiency anemia among adolescents ages years 99 and with insufficient iron stores low ferritin among pregnant females This survey also found lower serum concentrations of vitamin A among both younger and older adults and vitamin E older adults only in those of food-insufficient households compared to food-sufficient households; yet, the mean concentrations for these micronutrients were above the cutoffs typically associated with even marginal deficiency In another analysis of data from NHANES III, old ages years food-insufficient individuals had lower intakes of several micronutrients compared to those who were classified as food-sufficient However, both groups had average micronutrient intakes above the EAR with the exception of magnesium, in which intakes were lower than the requirement in both groups Lower socioeconomic status has been linked to lower intakes of micronutrients, including most of the 'shortfall' nutrients NHANES Differences in micronutrient intakes between low and high socioeconomic status might be attributed to differences in food security, food diversity, and use of supplements In addition, the Seattle Obesity Study men and women found a direct link between the price of food and the level of micronutrient intake Obesity is associated with an increased risk of a number of chronic diseases , including high blood pressure , type 2 diabetes mellitus , liver and gallbladder disease, osteoarthritis , sleep apnea , and certain cancers.
Although multifactorial in etiology , obesity is linked with consumption of an energy-dense, nutrient-poor diet. Obese individuals generally consume excessive calories i. In particular, it is well established that obesity increases the risk of vitamin D deficiency. Once vitamin D is synthesized in the skin or ingested, it can be sequestered in body fat stores, making it less bioavailable to people with higher body fat mass see the article on Vitamin D.
Accordingly, the prevalence of inadequacy for vitamins A, C, D, and E; calcium; and magnesium was higher among obese individuals compared to those of normal weight, and additionally, the proportion of obese adults that met the AI for potassium was smaller compared to normal-weight adults As mentioned above, morbidly obese individuals have preexisting micronutrient deficiencies before they undergo bariatric surgery.
Bariatric weight-loss surgery to treat morbid obesity can further increase the risk of micronutrient deficiencies due to decreased food intake and surgical alteration of the gastrointestinal tract. Most micronutrients are absorbed in the upper small intestine , which is often removed or bypassed in certain types of bariatric surgeries, and gastric , biliary , and pancreatic secretions are important for nutrient absorption While the recommendations for nutrient supplementation vary by the specific type of surgery e.
Supplementation with other micronutrients, including thiamin; vitamins A, B 12 , C, and K; iron; zinc; and possibly others may be needed depending on the specific type of surgical procedure Nutritional evaluation and counseling of the patient must be done prior to and following bariatric surgery, and supplemental micronutrient recommendations should be tailored to individual needs Most micronutrients are absorbed in the upper small intestine duodenum and jejunum , although some nutrients e.
The causes of malnutrition in IBD patients are multifactorial and include 1 reduced food intake and avoidance of certain foods or food groups; 2 impaired micronutrient absorption e. IBD patients have been reported to experience deficiencies in multiple micronutrients; the below discussion includes the more commonly reported deficiencies that have clinical relevance.
Deficiencies or inadequacies in other micronutrients not discussed may also be present in IBD patients. However, the exact prevalence is difficult to estimate because the typically reliable measures of iron status , like serum ferritin an iron-storage protein that is an acute-phase reactive protein , are affected by inflammation.
While other measures of iron status transferrin saturation, soluble transferrin receptor are often assessed in IBD patients, the diagnosis of iron deficiency is made using serum ferritin in the absence or presence of inflammation. The most severe level of iron deficiency is iron-deficiency anemia see the article on Iron.
IBD disease activity has also been positively associated with the degree of anemia. Thus, it is prudent that iron status be monitored in IBD patients and, when necessary, treated with iron supplementation Iron may also be administered parenterally reviewed in Vitamin B 12 , complexed to intrinsic factor, is absorbed by a receptor -mediated process in the ileum — the distal section of the small intestine.
Vitamin B 12 status in IBD patients should be monitored by assessing blood concentration of methylmalonic acid, the specific indicator of vitamin B 12 deficiency; assessing blood concentration of homocysteine may also be useful in assessing vitamin B 12 status in IBD patients However, many studies on the association have employed serum folate concentration, an indicator of only recent dietary folate intake, to assess body folate status.
Red blood cell folate concentration better reflects tissue folate stores and body folate status Use of certain medications may cause folate deficiency. In particular, patients taking the pharmaceuticals sulfasalazine an inhibitor of the reduced folate carrier that mediates cellular uptake, which is used to treat rheumatoid arthritis and ulcerative colitis or methotrexate a tetrahydrofolate reductase inhibitor and folate antagonist used to treat cancer , rheumatoid arthritis, and psoriasis are at increased risk of folate deficiency , and should follow the advice of their physician or pharmacist regarding supplemental folic or folinic acid.
IBD patients are at a heightened risk of low bone mineral density , osteoporosis , and osteopenia Adequate intake of calcium is critical throughout life to maintain bone health; dietary calcium intake is low in the US population, and calcium is considered a nutrient of public health concern However, the efficacy of calcium supplementation to prevent bone loss in IBD patients has not been examined in long-term intervention trials.
Ecologic studies have found a higher prevalence of IBD in populations residing in temperate climates compared to those living near the equator reviewed in , suggesting that IBD may be linked to vitamin D inadequacy.
While additional studies are needed to confirm the therapeutic efficacy of vitamin D in IBD, vitamin D supplementation is commonly recommended to decrease disease activity and relapse and improve bone mineral density in IBD patients Regarding drug interactions, the Endocrine Society recommends monitoring vitamin D status of patients treated with glucocorticoids because these medications increase the catabolism of hydroxyvitamin D 5.
Vitamin D supplementation is typically recommended in IBD patients treated with corticosteroids. Serum or plasma concentration of zinc is typically used in studies to assess zinc status , but measuring blood concentration is not a sensitive indicator of marginal deficiency. Blood concentrations of zinc are also known to be depressed in inflammatory states ; therefore, studies assessing circulating concentrations of zinc in IBD patients are difficult to interpret.
Persistent diarrhea contributes to zinc deficiency, and zinc supplementation may be needed in patients with significant and chronic diarrhea Micronutrient insufficiencies are common in dialysis patients for several reasons, including reduced appetite, restricted diets e.
Medications may also interfere with nutrient absorption, and the uremia may alter metabolism. Moreover, the increased oxidative stress and chronic inflammation experienced by dialysis patients may require increased intake of certain micronutrients, such as antioxidants e.
Multivitamin supplements that are specifically formulated for dialysis patients are available; these usually contain higher amounts of B vitamins thiamin, vitamin B 6 , folic acid, vitamin B 12 and vitamin C to compensate for losses of these micronutrients during the dialysis procedure.
Such multivitamins do not contain vitamin A because vitamin A status is increased in dialysis patients, and supplementation with this vitamin may lead to toxicity in this patient population Certain B vitamins are needed to decrease blood concentrations of homocysteine in dialysis patients; elevated levels of homocysteine are a risk factor for cardiovascular disease and possibly dementia. Additionally, vitamin C intake is generally low in dialysis patients as low-potassium diets are often low in vitamin C.
Vitamin D is another micronutrient of concern: Vitamin D status is reportedly low in dialysis patients, and patients with kidney disease have been traditionally given the active form of vitamin D 1,dihydroxyvitamin D or a vitamin D analog Mineral intake and status of dialysis patients should also be closely monitored as patients are at risk of both deficiency and excess of certain minerals and trace elements Certain medications can affect micronutrient status by altering nutrient absorption or utilization, and conversely, some micronutrients — from food or supplements — can alter the pharmacokinetics or pharmacodynamics of certain drugs , Older individuals are especially susceptible to drug-nutrient interactions due to impaired metabolism , increased risk of malnutrition, and prevalent use of prescription drugs Physicians, pharmacists, and dietitians need to consider potential drug-nutrient interactions and recommend ways to prevent adverse effects Some medications should be taken with a meal to maximize drug bioavailability , while others should be taken in a fasting state — refer to the patient information leaflet accompanying the medication or consult a pharmacist for specific instructions.
Although drug-nutrient interactions have not been systematically studied, there are a number of known interactions reported in the scientific literature. The list below is not meant to be comprehensive but includes some of the more common clinically relevant drug-nutrient interactions, especially because they may result in micronutrient inadequacy. For more comprehensive lists, see the suggested references.
Long-term use of the drug is often needed to reach such a threshold and for clinical symptoms of the drug-nutrient interaction to manifest For information regarding drug interactions with a particular micronutrient, see the "Drug interactions" section in the separate articles on the individual vitamins and minerals links included in Table 6 below , as well as the suggested references.
Antacids are commonly used to neutralize stomach acid and thus to treat heartburn and indigestion; proton-pump inhibitors e.
Use of these medications may alter nutrient absorption such that intake may need to be separated from food or supplemental intake by two to three hours. Although data are limited, use of antacids or gastric acid suppressants might slightly impair absorption of folate from supplemental folic acid Separating folic acid supplementation by drug use by three hours would avoid any potential interaction. Proton-pump inhibitors markedly decrease stomach acid secretion required for the release of vitamin B 12 from food but not from supplements.
Long-term use of proton-pump inhibitors has been found to decrease blood vitamin B 12 concentrations. However, vitamin B 12 deficiency does not generally develop until after at least three years of continuous therapy , Use of histamine H 2 - receptor antagonists has also been found to decrease the absorption of vitamin B 12 from food. It is not clear whether the long-term use of H 2 -receptor antagonists could cause overt vitamin B 12 deficiency , Individuals taking drugs that inhibit gastric acid secretion should consider taking vitamin B 12 in the form of a supplement because gastric acid is not required for its absorption.
Hypercalcemia has been initially reported with the consumption of large quantities of calcium supplements in combination with antacids, particularly in the days when peptic ulcers were treated with large quantities of milk, calcium carbonate antacid , and sodium bicarbonate absorbable alkali. This condition is termed calcium-alkali syndrome formerly known as milk-alkali syndrome and has been associated with calcium supplement levels from 1.
Since the treatment for peptic ulcers has evolved and because of the widespread use of over-the-counter calcium supplements, the demographic of this syndrome has changed such that those at greater risk are now postmenopausal women, pregnant women, transplant recipients, patients with bulimia, and patients on dialysis , rather than men with peptic ulcers reviewed in Aluminum-containing antacids can decrease the absorption of fluoride.
It is best to take these products two hours before or after fluoride supplements Medications that decrease stomach acidity, such as antacids, histamine H 2 receptor antagonists e. Symptoms of magnesium toxicity, including nausea, vomiting, respiratory problems, and heart block, have occurred in people with impaired kidney function taking magnesium-containing antacids Magnesium-containing antacids may decrease the absorption of manganese if taken together with manganese-containing foods or supplements Aluminum-containing antacids reduce the absorption of dietary phosphorus by forming aluminum phosphate, which cannot be absorbed by the body.
When consumed in high doses, aluminum-containing antacids can lead to abnormally low blood phosphorus concentration hypophosphatemia , as well as aggravate phosphorus deficiency due to other causes The reduction of stomach acidity by proton-pump inhibitors may also limit the efficacy of phosphate-binder therapy in patients with kidney failure A number of antibiotics can affect micronutrient absorption, or conversely, certain micronutrients — from food or supplements — may affect absorption or efficacy of some antibiotics.
Table 4 lists some of the known micronutrient-antibiotic interactions; however, this list is not comprehensive. Some oral anticoagulants , such as warfarin Coumadin, Jantoven , inhibit coagulation by antagonizing the action of vitamin K.
Warfarin prevents recycling of vitamin K by blocking the enzyme , vitamin K oxidoreductase, thereby creating a functional vitamin K deficiency. Low dietary intakes of vitamin K can cause an unstable international normalized ratio INR Large supplemental doses of vitamin E may inhibit vitamin K-dependent carboxylase activity and interfere with the coagulation cascade Thus, the use of vitamin E supplements may increase the risk of bleeding in individuals taking warfarin and other anticoagulant drugs, as well as antiplatelet drugs and non-steroidal anti-inflammatory drugs NSAIDs like aspirin, ibuprofen, and others.
There is some evidence from case reports , though limited and controversial, that large oral doses of vitamin C may inhibit the action of warfarin , , requiring an increase in warfarin dose to maintain its effectiveness.
Pharmacologic doses of potassium iodide may decrease the anticoagulant effect of warfarin High intakes of other nutrients or phytochemicals may affect platelet aggregation and coagulation.
See Table 5 for links to the "Drug interactions" section in articles on individual nutrients, phytochemicals, or foods; this list is not meant to be comprehensive. Individuals on long-term anticonvulsant anti- seizure therapy, including primidone Mysoline , phenytoin Dilantin , and carbamazepine Carbatrol, Tegretol , have been found to have reduced blood biotin concentrations, as well as an increased urinary excretion of organic acids e.
Potential mechanisms for these effects may include inhibition of biotin intestinal absorption, decreased renal reabsorption, and increased biotin catabolism Use of the anticonvulsant valproic acid in children has resulted in hair loss reversed by biotin supplementation The anticonvulsant, phenytoin, has been shown to inhibit the intestinal absorption of folate, and several studies have associated decreased folate status with long-term use of the anticonvulsants, phenytoin, phenobarbital, and primidone However, few studies controlled for differences in dietary folate intake between anticonvulsant users and nonusers.
Reduced blood concentrations of thiamin have been reported in individuals with seizure disorders epilepsy taking the anticonvulsant medication, phenytoin, for long periods of time High doses of vitamin B 6 have been found to decrease the efficacy of two anticonvulsants, phenobarbital and phenytoin Author information Article notes Copyright and License information Disclaimer.
MSD drib. MSD rehcsibea. MSD refrodsregge. MSD sniurb. Received Sep 6; Accepted Dec This article has been cited by other articles in PMC. Abstract Surveys in high-income countries show that inadequacies and deficiencies can be common for some nutrients, particularly in vulnerable subgroups of the population. Keywords: nutrient inadequacies and deficiencies, nutritional supplements, biomarkers, nutrition screening, public health, cost-effectiveness.
Introduction Primary prevention in the nutrition setting aims to control risk factors in the general population, such as the dissemination of dietary recommendations to improve nutritional knowledge and enable behavior change [ 1 ]. Nutrient Inadequacies and Deficiencies There are a number of interacting factors that can contribute to marginal or low nutrient status, including poor dietary quantity or quality, increased requirements, increased metabolic losses, or impaired gastrointestinal digestion or absorption [ 9 ].
Public Health Problem of Inadequate Intakes and Deficiencies of Nutrients Surveys show that, even in high-income countries, nutrient intakes fail to meet requirements for many people, and overall nutrient status is too low for several essential nutrients [ 27 ]. Open in a separate window. Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Common Approaches to Prevent Nutrient Inadequacies and Deficiencies Policy makers are increasingly aware of the public burden and associated costs of under- and over-nutrition.
Criteria Determining Cost-Effectiveness A health economic assessment is necessary to judge whether dietary advice and managing nutrient deficiencies in high-risk groups can be cost-effective, and to come to possible recommendations. Public Health and Economic Consequences First, the public health and economic consequences of nutrient inadequacies and deficiencies are the primary consideration for developing health care policy. Evidence Base Supporting Improved Health Outcomes, Discomfort and Risks Second, in order to be cost-effective, provision of dietary services or dietary supplements to at-risk groups should lead to the expected improved health outcomes.
Availability of an Accurate Test A prerequisite to screen individuals at-risk for specific nutrient inadequacies or deficiencies is the availability of a suitable test that has sufficient sensitivity and specificity.
Adoption and Adherence Third, the effectiveness of an intervention in primary health care strongly depends on its awareness and adoption among health care practitioners; i. Costs and Cost Savings Finally, the expected total direct and indirect costs and cost-savings of a secondary prevention strategy should be considered.
Figure 6. Evidence Gaps in Evaluating Secondary Nutrition Strategies There are several challenges inherent to coming to recommendations for secondary nutrition strategies targeted at subgroups of biggest concern. Discussion A risk-benefit balance followed by a more thorough cost-effectiveness assessment will allow for well-balanced recommendations for addressing nutrition deficiencies of major public health concern in a secondary prevention strategy.
Conclusions National survey data show that adequate nutrient intakes and sufficient status may be difficult to achieve across all age and gender groups. Author Contributions M. Conflicts of Interest The authors are employed by DSM Nutritional Products, a manufacturer of vitamins and supplier to the food, dietary supplement, and pharmaceutical industries.
Funding The authors reported no funding received for this study. References 1. Boyle M. Herring D. Montagnese C. North and south american countries food-based dietary guidelines: A comparison. European food-based dietary guidelines: A comparison and update. Pfeiffer C. Population is a valuable tool for researchers and policy makers. Spiro A. Vitamin D: An overview of vitamin D status and intake in Europe. Troesch B. Dietary surveys indicate vitamin intakes below recommendations are common in representative western countries.
Diethelm K. Nutrient intake of european adolescents: Results of the helena healthy lifestyle in Europe by nutrition in adolescence study.
Public Health Nutr. Herbert V. The five possible causes of all nutrient deficiency: Illustrated by deficiencies of vitamin B12 and folic acid. Serra-Majem L. Determinants of nutrient intake among children and adolescents: Results from the enkid study. Cordain L. Origins and evolution of the western diet: Health implications for the 21st century.
Marangoni F. Maternal diet and nutrient requirements in pregnancy and breastfeeding. An Italian consensus document. Dewey K. The challenge of meeting nutrient needs of infants and young children during the period of complementary feeding: An evolutionary perspective. Story M. Nutrient needs during adolescence and pregnancy: A practical reference guide. In: Story M.
Nutrient Needs during Adolescence and Pregnancy. Chapter 5. Leslie W. Aging, nutritional status and health. Mehta N. Nutritional deficiencies during critical illness. Berger M. Key vitamins and trace elements in the critically ill. Nestle Nutr. Workshop Ser. Wong C. Vitamin B12 deficiency in the elderly: Is it worth screening? Hong Kong Med. Hurrell R. Iron bioavailability and dietary reference values. West C.
Consequences of revised estimates of carotenoid bioefficacy for dietary control of vitamin A deficiency in developing countries. Reilly W. Prescription drugs and nutrient depletion: How much is known? Stover P. Influence of human genetic variation on nutritional requirements. Suskind D. Nutritional deficiencies during normal growth. Weininger J. Nutritional Disease: Nutrient Deficiencies. Tinker S. Women of childbearing age who are at possible increased risk of a neural tube defect-affected pregnancy due to suboptimal red blood cell folate concentrations, national health and nutrition examination survey to Birth Defects Res.
Part A Clin. Peter S. Selected nutrients and their implications for health and disease across the lifespan: A roadmap. Darnton-Hill I. Micronutrient deficiencies and gender: Social and economic costs. Departments of Agriculture and Health and Human Services. Part D. Chapter 1: Food and nutrient intakes, and health: Current status and trends. Marvin-Dowle K. Nutrient intakes and nutritional biomarkers in pregnant adolescents: A systematic review of studies in developed countries.
BMC Pregnancy Childbirth. Blumfield M. A systematic review and meta-analysis of micronutrient intakes during pregnancy in developed countries. Other good sources of thiamine include:. Niacin is another mineral that helps the body convert food into energy. A severe deficiency in niacin is often referred to as pellagra. Niacin is found in most animal proteins but also in peanuts.
As a result, this condition is rare in industrialized countries or in meat-eating communities. Symptoms of pellagra include diarrhea , dementia, and skin disorders.
You can usually treat it with a balanced diet and vitamin B-3 supplements. Shop for vitamin B-3 supplements. Vitamin B-9 helps the body create red blood cells and produce DNA. Folate also helps brain development and nervous system functioning. Folic acid is the synthetic form found in supplements or fortified foods. Folate is especially important for fetal development. Folate deficiency can lead to severe birth defects , growth problems, or anemia.
While beans can provide a great amount of folate, the folate content in canned beans is about half of what cooked, dried beans offer. Most people in the United States get enough folate. In these cases, while folate intake might be adequate, a supplement of methylated folate may be necessary to prevent deficiency. Deficiency in this vitamin is common among people who:.
Intrinsic factor is a transport protein secreted by the stomach cells. It binds to B and takes it to the small intestine for absorption. This is the way the body is able to absorb and utilize B Adequate calcium intake at meals is required for intrinsic factor to assist in B absorption in the small intestine. A deficiency in this vitamin may cause pernicious anemia. This is a type of anemia caused by a decreased ability to absorb B efficiently. Pernicious anemia is more common in people with autoimmune disorders and inflammatory or digestive diseases.
Left untreated for too long, vitamin B deficiency may cause irreversible damage to the nervous system. More severe symptoms include:. Your doctor can order a variety of blood tests to check for vitamin B deficiency. Blood tests can check for:. Vitamin B is commonly found in red meat and animal products. Vegetarian sources include fortified plant-based milks and nutritional yeast.
People with darker skin tones are at a higher risk of vitamin D deficiency. Vitamin D is essential for healthy bones. It helps the body maintain the right levels of calcium in order to regulate the development of teeth and bones. A lack of this nutrient can lead to stunted or poor bone growth. Osteoporosis , caused by a lack of calcium and vitamin D, can lead to porous and fragile bones that break very easily.
The best source of vitamin D is sunlight.
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