Many Americans have inadequate intakes of several nutrients. The Dietary Guidelines for Americans 2015-2020 specifically identified vitamins A, C, D and E, calcium, magnesium, iron, potassium, choline and fiber as "underconsumed nutrients". Based on nationally representative data in 10,698 adults from National Health and Nutrition Examination Surveys (NHANES), 2009-2012, assessments were made of age-group differences in the impact of dietary supplements on nutrient intake and inadequacies. Compared to food alone, use of any dietary supplement plus food was associated with significantly (p < 0.01) higher intakes of 15-16 of 19 nutrients examined in all age groups; and significantly reduced rates of inadequacy for 10/17, 8/17 and 6/17 nutrients examined among individuals age ≥71, 51-70 and 19-50 years, respectively. Compared to the other age groups, older adults (≥71 years) had lower rates of inadequacy for iron and vitamins A, C, D and E, but higher rates for calcium. An increased prevalence of intakes above the Tolerable Upper Intake Level was seen for 8-9 of 13 nutrients, but were mostly less than 5% of the population. In conclusion, dietary supplement use is associated with increased micronutrient intake, decreased inadequacies, and slight increases in prevalence above the UL, with greater benefits seen among older adults.

The U.S. Centers for Disease Control and Prevention has reported that nutritional deficiencies in the U.S. population vary by age, gender, and race/ethnicity, and could be as high as nearly one third of certain population groups. Based on nationally representative data in 10,698 adults from National Health and Nutrition Examination Surveys (NHANES) primarily from 2009-2012, assessments were made of race/ethnic differences in the impact of dietary supplements on nutrient intake and prevalence of inadequacies. Compared to food alone, use of any dietary supplement plus food was associated with significantly higher intakes of 14 to 16 of 19 nutrients examined in all race/ethnic groups; and significantly (p < 0.01) reduced rates of inadequacy for 8/17 nutrients examined in non-Hispanic whites, but only 3-4/17 nutrients (calcium, and vitamins A, D, and E) for other race/ethnic groups. Across race/ethnic groups an increased prevalence of intakes above the Tolerable Upper Intake Level (UL) was seen for 1-9/13 nutrients, but all were less than 5% of the population. In conclusion, use of dietary supplements is associated with increased micronutrient intake, decreased nutrient inadequacies, and slight increases in prevalence above the UL in all race/ethnicities examined, with greater benefits among non-Hispanic whites.

Although >50% of U.S. adults use dietary supplements, little information is available on the impact of supplement use frequency on nutrient intakes and deficiencies. Based on nationally representative data in 10,698 adults from the National Health and Nutrition Examination Surveys (NHANES) 2009 to 2012, assessments were made of intakes from food alone versus food plus multi-vitamin/multi-mineral supplements (MVMS) of 17 nutrients with an Estimated Average Requirement (EAR) and a Tolerable Upper Intake Level (UL), and of the status of five nutrients with recognized biomarkers of deficiency. Compared to food alone, MVMS use at any frequency was associated with a lower prevalence of inadequacy (p < 0.01) for 15/17 nutrients examined and an increased prevalence of intakes >UL for 7 nutrients, but the latter was ≤4% for any nutrient. Except for calcium, magnesium, and vitamin D, most frequent MVMS use (≥21 days/30 days) virtually eliminated inadequacies of the nutrients examined, and was associated with significantly lower odds ratios of deficiency for the examined nutrient biomarkers except for iron. In conclusion, among U.S. adults, MVMS use is associated with decreased micronutrient inadequacies, intakes slightly exceeding the UL for a few nutrients, and a lower risk of nutrient deficiencies.

Limiting dietary sodium intake has been a consistent dietary recommendation. Using NHANES 2007-2010 data, we estimated current sodium intake and modeled the potential impact of a new sodium reduction technology on sodium intake. NHANES 2007-2010 data were used to assess current sodium intake. The National Cancer Institute method was used for usual intake determination. Suggested sodium reductions using SODA-LO (®) Salt Microspheres ranged from 20% to 30% in 953 foods and usual intakes were modeled by using various reduction factors and levels of market penetration. SAS 9.2, SUDAAN 11, and NHANES survey weights were used in all calculations with assessment across gender and age groups. Current (2007-2010) sodium intake (mg/day) exceeds recommendations across all age gender groups and has not changed during the last decade. However, sodium intake measured as a function of food intake (mg/g food) has decreased significantly during the last decade. Two food categories contribute about 2/3rd of total sodium intake: "Grain Products" and "Meat, Poultry, Fish & Mixtures". Sodium reduction, with 100% market penetration of the new technology, was estimated to be 230-300 mg/day or 7-9% of intake depending upon age and gender group. Sodium reduction innovations like SODA-LO (®) Salt Microspheres could contribute to meaningful reductions in sodium intake.

High-quality diets reduce the risk of cardiometabolic and other chronic diseases. The dietary components that distinguish higher from lower quality diets, and their associations with health, have not been fully investigated.

Most children do not meet the recommendation for fruit consumption. Apples are the second most commonly consumed fruit in the US; however, no studies have examined the association of total apple products, apples, apple sauce, and 100 % apple juice consumption on diet quality and weight/adiposity in children.

This study determined and compared the mean daily intake of energy and nutrients from processed foods by level of processing (minimally processed; processed for preservation, nutrient enhancement, and freshness; mixtures of combined ingredients; ready-to-eat processed foods; and prepared foods/meals) among non-Hispanic white, non-Hispanic black, and Mexican American US children. Data from participants 2-18 years old (n = 10,298) of the nationally representative cross-sectional National Health and Nutrition Examination Survey 2003-2008 with a complete one day, 24-h dietary recall were used to determine mean intake of energy and nutrients recommended for increase and decrease, as per the 2010 Dietary Guidelines for Americans, among child race/ethnic groups by category of food processing. Regression analysis was used to estimate and compare covariate-adjusted (gender, age, and poverty-income-level) least square means (p < 0.05/3 race/ethnic groups). All children, regardless of race or ethnicity consumed processed foods. Approximately 66% to 84% of total daily energy, saturated fat, cholesterol, fiber, total sugar, added sugars, calcium, vitamin D, potassium, and sodium intake are contributed by one of the five categories of processed foods. Clinicians and policy should primarily advise consideration of the energy and nutrient composition of foods, rather than the processing level, when selecting a healthy diet for children.

Identification of current food sources of energy and nutrients among US adults is needed to help with public health efforts to implement feasible and appropriate dietary recommendations. To determine the food sources of energy and 26 nutrients consumed by US adults the 2003-2006 National Health and Nutrition Examination Survey (NHANES) 24-h recall (Day 1) dietary intake data from a nationally representative sample of adults 19+ years of age (y) (n = 9490) were analyzed. An updated USDA Dietary Source Nutrient Database was developed for NHANES 2003-2006 using current food composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from food sources were sample-weighted. Percentages of total dietary intake contributed from food sources were ranked. The highest ranked sources of energy and nutrients among adults more than 19 years old were: energy - yeast bread/rolls (7.2%) and cake/cookies/quick bread/pastry/pie (7.2%); protein-poultry (14.4%) and beef (14.0%); total fat - other fats and oils (9.8%); saturated fatty acids - cheese (16.5%) and beef (9.1%); carbohydrate - soft drinks/soda (11.4%) and yeast breads/rolls (10.9%); dietary fiber - yeast breads/rolls (10.9%) and fruit (10.2%); calcium - milk (22.5%) and cheese (21.6%); vitamin D - milk (45.1%) and fish/shellfish (14.4%); and potassium - milk (9.6%) and coffee/tea/other non-alcoholic beverages (8.4%). Knowledge of primary food sources of energy and nutrients can help health professionals design effective strategies to reduce excess energy consumed by US adults and increase the nutrient adequacy of their diets.

One hundred percent fruit juice (100% FJ) has been viewed by some as a sweetened beverage with concerns about its effect on weight. Little regard has been given to the contribution of 100% FJ to diet quality.

Dietary phosphorus intake in the USA has been consistently greater than the Recommended Daily Allowance (RDA) with several studies reporting associations between intake and health risks as well as all-cause mortality within healthy subjects and patients with chronic kidney disease (CKD). The current study utilized a novel approach to calculate added phosphorus content in foods to determine sources (National Health and Nutrition Examination Survey, NHANES 2001-2016, n = 39,796) and trends in consumption (NHANES 1988-1994, 2001-2016, n = 55,744) of total, naturally occurring, and added phosphorus. Among adults (19+ years), the mean intake of total and natural phosphorus (mg/day) in 1988-1994 as compared with 2015-2016 increased (total: 1292 ± SE 11 vs. 1398 ± SE 17; natural: 1113 ± SE 10 vs. 1243 ± SE 16 mg/day); in contrast, added phosphorus intake decreased during this time (178 ± SE 2.9 vs. 155 ± SE 4.1 mg/day). Added phosphorus as a percent of total ranged from about 14.6% in 1988-1994 to about 11.6% in 2015-2016. The top five sources of total and naturally occurring phosphorus, representing approximately 20% of intake, were cheese, pizza, chicken (whole pieces), reduced-fat milk, and eggs/omelets. The top five sources of added phosphorus were cheese, soft drinks, cakes/pies, rolls/buns, and cookies/brownies, representing 45% of added phosphorus in the diet. Consumption of added phosphorus has decreased over the past few decades, possibly due to increased demand for foods with less additives/ingredients but may also be due to inaccurate phosphorus values in nutrition databases. Further studies are needed to validate the added phosphorus calculations utilized in this study and nutrition databases should consider providing added phosphorus content.

Recent estimates of added sugars intake among the U.S. population show intakes are above recommended levels. Knowledge about the sources of added sugars contributing to intakes is required to inform dietary guidance, and understanding how those sources vary across sociodemographic subgroups could also help to target guidance. The purpose of this study was to provide a comprehensive update on sources of added sugars among the U.S. population, and to examine variations in sources according to sociodemographic factors. Regression analyses on intake data from NHANES 2011-18 were used to examine sources of added sugars intake among the full sample (N = 30,678) and among subsamples stratified by age, gender, ethnicity, and income. Results showed the majority of added sugars in the diet (61-66%) came from a few sources, and the top two sources were sweetened beverages and sweet bakery products, regardless of age, ethnicity, or income. Sweetened beverages, including soft drinks and fruit drinks, as well as tea, were the largest contributors to added sugars intake. There were some age-, ethnic-, and income-related differences in the relative contributions of added sugars sources, highlighting the need to consider sociodemographic contexts when developing dietary guidance or other supports for healthy eating.

Consuming live microbes in foods may benefit human health. Live microbe estimates have not previously been associated with individual foods in dietary databases.

Micronutrients play a pivotal role in achieving and maintaining optimum health across all life stages. Much of the U.S. population fails to meet Estimated Average Requirements (EARs) for key nutrients. This analysis aims to assess the contribution of fortified ready-to-eat cereals (RTEC) to micronutrient intake for U.S. residents aged 2-18, 19-99, and 2-99 years of age according to National Health and Nutrition Examination Survey (NHANES) 2007-2010 data. We used the National Cancer Institute (NCI) method to assess usual intake of 21 micronutrients and the percentage of the population under EARs and above Tolerable Upper Intake Levels (UL). Without fortification of RTECs, the percentage of those aged 2-18 years that were below EARs increased by 155, 163, 113, and 35% for niacin, iron, thiamin, and vitamin A, respectively. For vitamins B6 and zinc, the respective numbers were 118% and 60%. Adults aged 19-99 and 2-99 had lower percentages but similar outcomes. RTECs are associated with improved nutrient adequacy and do not widely affect prevalence above the UL. The data indicate that large proportions of the population fail to achieve micronutrient sufficiency without fortification, and that its use can help Americans reach national nutrient intake goals.

Nutrient adequacy of tree nut consumers has not been examined. The National Health and Nutrition Examination Survey 2005-2010 data were used to assess the association of tree nut consumption by adults 19+ years (n = 14,386) with nutrient adequacy and diet quality. Covariate adjusted usual intake was determined using two 24-h dietary recalls and the National Cancer Institute method. Percentages of the consumption groups below the Estimated Average Requirement (EAR) or above the Adequate Intake (AI) were determined. Diet quality was determined using the Healthy Eating Index-2005 (HEI) score. Usual intake data showed consumers of tree nuts had a lower percentage (p < 0.0001) of the population below the EAR for vitamins A (22 ± 5 vs. 49 ± 1), E (38 ± 4 vs. 94 ± 0.4) and C (17 ± 4 vs. 44 ± 1); folate (2.5 ± 1.5 vs. 12 ± 0.6); calcium (26 ± 3 vs. 44 ± 1); iron (3 ± 0.6 vs. 9 ± 0.4); magnesium (8 ± 1 vs. 60 ± 1); and zinc (1.5 ± 1 vs. 13 ± 1). Tree nut consumers had a higher percentage (p < 0.0001) of the population above the AI for fiber (33 ± 3 vs. 4 ± 0.3) and potassium (12 ± 3 mg vs. 2 ± 0.2 mg). HEI-2005 total score was higher (p < 0.0001) in tree nut consumers (61 ± 0.7 vs. 52 ± 0.3) than non-consumers. Health professionals should encourage the use of tree nuts as part of a dietary approach to healthy eating.

Different methods for determining the effect of added sugars intake among children and adults on meeting recommended nutrient intakes were compared using 24 h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Four methods were used to determine deciles of added sugars intake (as the percentage of total calories): 1 day intake, 2 day average intake, and individual usual intake (UI) determined with the National Cancer Institute (NCI) and the multivariate Markov Chain Monte Carlo methods. Percentages of the population below the Estimated Average Requirement (EAR) for calcium and vitamin D/above the Adequate Intake (AI) for potassium and dietary fiber for each decile of added sugars intake were assessed with the NCI method. Using regression analyses, added sugars intake deciles (by any method) in children were inversely associated (p < 0.001) with percentages below the EAR/above the AI of vitamin D, calcium, potassium, and fiber. In adults, added sugars intake deciles were inversely associated with meeting recommendations for vitamin D, potassium, and fiber. There were no significant between-method differences for regression coefficients for any nutrients investigated. Overall, these methods showed a similar association of added sugars intake with nutrient inadequacy/adequacy; therefore, method preference may depend more on practical reasons.

Dietary patterns, including beverage consumption, that are developed during a child's first few years of life have been shown to impact dietary choices made later in life. Authoritative sources provide beverage recommendations for infants and children; however, it is unclear if these guidelines are followed and what, if any, the differences are among races/ethnicities. The objective of this study was to examine beverage consumption to recommendations among children 0-5 months, 6-11 months, 12-23 months, 2-3 years, and 4-5 years. Additionally, examine how these beverage patterns associate with nutrient intake and to determine if differences exist in beverage consumption among race/ethnic groups (Non-Hispanic White, Non-Hispanic Black, Hispanic, and Asian) in children aged 0-23 months, 2-3 years, and 4-5 years.

Live dietary microbes have been hypothesized to contribute to human health but direct evidence is lacking.

Over the past 2 decades, there has been an increased emphasis on added sugars intake in the Dietary Guidelines for Americans (DGA), which has been accompanied by policies and interventions aimed at reducing intake, particularly among children, adolescents, and teens.

Pork is a rich source of high-quality protein and select nutrients. The objective of this work was to assess the intakes of all pork (AP), fresh pork (FP) and processed pork (PP) and their association with nutrient intake and meeting nutrient recommendations using 24 h dietary recall data. Usual intake was determined using the NCI method and the percentage of the population with intakes below the Estimated Average Requirement, or above the Adequate Intake for pork consumers and non-consumers, was estimated. About 52, 15 and 45% of children and 59, 20 and 49% of adults were consumers of AP, FP and PP, respectively, with mean intakes in consumers of 47, 60 and 38 g/day for children and 61, 77 and 48 g/day for adults, respectively. Among consumers of AP, FP and PP, the intakes of copper, potassium, selenium, sodium, zinc, thiamine, niacin, vitamin B6 and choline were higher (p < 0.05) and a higher (p < 0.05) proportion met nutrient recommendations for copper, potassium, zinc, thiamin and choline compared to non-consumers. There were additional differences (p < 0.05) in intakes and adequacies for other nutrients between consumers and non-consumers depending upon the age group and pork type. In conclusion, pork intake was associated with higher intakes and adequacies in children and adults for certain key nutrients.

Nutritional equity has been recognized as a priority in nutrition research, as reiterated by the new life-stage approach utilized by the Dietary Guidelines for Americans. Two of the life stages focused on are pregnant and lactating females as well as older adults, due to their unique nutritional needs and unique chronic health conditions. Both groups have low intakes of several nutrients, including those of public health concern, and suboptimal diet quality, underlining the importance to improve their dietary intakes. Incorporating fruit into their diets could help alleviate these gaps. Thus, the objective of the current study is to expand upon our current knowledge of the benefits of fruit within these two subgroups that DGA guidelines focus on and determine nutrient and food group intake as well as diet quality in women of childbearing age (WCA; as a proxy for pregnant and/or lactating females, n = 16,774) and older adult (n = 18,784) mango consumers compared with non-consumers, using NHANES 1988-1994 and 1999-2018. Both WCA and older adult mango consumers had greater than 20% higher intakes of fiber and vitamin C and WCA consumers had upwards of 10% higher folate, magnesium, and potassium intakes compared with non-consumers. Both groups of consumers had lower intake of saturated fat and older adults had lower intakes of protein and vitamin B12. Diet quality was 16 and 13% higher in WCA and older adult consumers compared with non-consumers, respectively. Additionally, mango consumers had lower beef, poultry, fish, and solid fat intakes and WCA consumers had higher whole grain intakes compared with non-consumers. This study suggests incorporating mango into the diet could increase select nutrient intake as well as diet quality in specific life stages of adult Americans.