![]() 18 In the US, excessive intake was noted for vitamin A (97%) and zinc (68%) among toddlers who were given supplements. For example, in a Canadian national survey, over 80% of children aged 1-3 years who took dietary supplements consumed vitamin A and niacin at levels above the upper limit. 6 Although the overall proportion of US adults with intakes above the upper level is below 5% for most nutrients ( fig 2), some population subgroups may have high rates of excess intake. The widespread use of vitamin and mineral supplements in high income countries seems to contribute to an increase in population prevalence of intake above the upper tolerable level ( box 1). 15 In the US and other countries, food fortification and enrichment such as the addition of iodine to salt, vitamin D to milk, and B 1 and B 3 vitamins to refined flour have contributed to the virtual elimination of their syndromes of deficiency (goitre, rickets, beriberi, and pellagra, respectively). In low and middle income countries, where specific micronutrient deficiencies are prevalent (eg, of iodine, iron, zinc, and vitamin A), supplementation is recommended when food based approaches such as dietary modification, fortification, or food provision are unable to achieve inadequate intake. 14 Despite the high use of supplements, inadequate intakes of micronutrients are still common in high income countries, where dietary patterns are typically energy rich but nutrient poor. This is especially true for vitamins and minerals identified as “shortfall” nutrients such as calcium and vitamin D ( fig 2). As intake increases above the upper level, the potential risk of adverse effects increases.Įxcess intake-The population prevalence of excess intake is estimated as the percentage of the population with nutrient intake above the upper level Tolerable upper intake is the highest daily nutrient intake that is likely to pose no risk of adverse health effects to almost all healthy people in a population. Inadequate nutrient intake-The population prevalence of inadequate intake is estimated as the percentage of the population with nutrient intake below the estimated average requirement 11 12īox 1 Population nutrient intake-definitionsĮstimated average requirement is the daily level of nutrient intake estimated to meet the requirement of half of healthy people in a population 6 Importantly, people who use supplements tend to have a better overall diet quality than those who don’t use them and their nutrient intake from foods mostly meets recommended intake levels. 10 It also clusters with healthy lifestyle factors such as not being a smoker or heavy drinker, not being overweight or obese, and being physically active. 6 Supplement use correlates positively with educational and socioeconomic status. In the US, >70% of adults aged ≥65 years use supplements 8 compared with a third of children and adolescents. Supplement use varies considerably among population subgroups within North America and Europe. National survey data for supplement use in the general population remain scarce for low and middle income countries. 2 3 4 Different methods for assessing supplement use may contribute to the different prevalence in high income countries. Supplement use is generally less prevalent in other countries than in the US and Canada but varies widely (eg, Denmark 51%, South Korea 34%, Australia 43%, UK 36%, Spain 6%, Greece 2%). ![]()
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