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Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring.

ABSTRACT: The use of dietary supplements (DS) is pervasive and can provide substantial amounts of micronutrients to those who use them. Therefore when characterizing dietary intakes, describing the prevalence of inadequacy or excess, or assessing relations between nutrients and health outcomes, it is critical to incorporate DS intakes to improve exposure estimates. Unfortunately, little is known about the best methods to assess DS, and the structure of measurement error in DS reporting. Several characteristics of nutrients from DS are salient to understand when comparing to those in foods. First, DS can be consumed daily or episodically, in bolus form and can deliver discrete and often very high doses of nutrients that are not limited by energy intakes. These characteristics contribute to bimodal distributions and distributions severely skewed to the right. Labels on DS often provide nutrient forms that differ from those found in conventional foods, and underestimate analytically derived values. Finally, the bioavailability of many nutrient-containing DS is not known and it may not be the same as the nutrients in a food matrix. Current methods to estimate usual intakes are not designed specifically to handle DS. Two temporal procedures are described to refer to the order that nutrient intakes are combined relative to usual intake procedures, referred to as a "shrinking" the distribution to remove random error. The "shrink then add" approach is preferable to the "add then shrink" approach when users and nonusers are combined for most research questions. Stratifying by DS before usual intake methods is another defensible option. This review describes how to incorporate nutrient intakes from DS to usual intakes from foods, and describes the available methods and fit-for-purpose of different analytical strategies to address research questions where total usual intakes are of interest at the group level for use in nutrition research and to inform policy decisions. Clinical Trial Registry: NCT03400436.

SUBMITTER: Bailey RL

PROVIDER: S-EPMC6374152 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring.

Bailey Regan L RL Dodd Kevin W KW Gahche Jaime J JJ Dwyer Johanna T JT Cowan Alexandra E AE Jun Shinyoung S Eicher-Miller Heather A HA Guenther Patricia M PM Bhadra Anindya A Thomas Paul R PR Potischman Nancy N Carroll Raymond J RJ Tooze Janet A JA

The Journal of nutrition 20190201 2

The use of dietary supplements (DS) is pervasive and can provide substantial amounts of micronutrients to those who use them. Therefore when characterizing dietary intakes, describing the prevalence of inadequacy or excess, or assessing relations between nutrients and health outcomes, it is critical to incorporate DS intakes to improve exposure estimates. Unfortunately, little is known about the best methods to assess DS, and the structure of measurement error in DS reporting. Several characteri ...[more]

PMID: 30753685

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Project description:BackgroundThe US Dietary Guidelines will expand in 2020 to include infants and toddlers. Understanding current dietary intakes is critical to inform policy.ObjectiveThe purpose of this analysis was to examine the usual total nutrient intakes from diet and supplements among US children.MethodsThe Feeding Infants and Toddlers Study 2016 is a national cross-sectional study of children aged <48 mo (n = 3235): younger infants (birth to 5.9 mo), older infants (6-11.9 mo), toddlers (12-23.9 mo), younger preschoolers (24-36.9 mo), and older preschoolers (36-47.9 mo) based on the use of a 24-h dietary recall. A second 24-h recall was collected from a representative subsample (n = 799). Energy, total nutrient intake distributions, and compliance with Dietary Reference Intakes were estimated with the use of the National Cancer Institute method.ResultsDietary supplement use was 15-23% among infants and toddlers and 35-45% among preschoolers. Dietary intakes of infants were adequate, with mean intakes exceeding Adequate Intake for all nutrients except vitamins D and E. Iron intakes fell below the Estimated Average Requirement for older infants (18%). We found that 31-33% of children aged 12-47.9 mo had low percentage of energy from total fat, and >60% of children aged 24-47.9 mo exceeded the saturated fat guidelines. The likelihood of nutrient inadequacy for many nutrients was higher for toddlers: 3.2% and 2.5% greater than the Adequate Intake for fiber and potassium and 76% and 52% less than the Estimated Average Requirement for vitamins D and E, respectively. These patterns continued through older ages. Intakes exceeded the Tolerable Upper Intake Level of sodium, retinol, and zinc across most age groups.ConclusionsDietary intakes of US infants are largely nutritionally adequate; concern exists over iron intakes in those aged 6-11.9 mo. For toddlers and preschoolers, high intake of sodium and low intakes of potassium, fiber, and vitamin D and, for preschoolers, excess saturated fat are of concern. Excess retinol, zinc, and folic acid was noted across most ages, especially among supplement users.

Project description:BackgroundCrossFit® is a popular high-intensity functional training program. CrossFit® participants may practice popular diets or consume dietary and sports supplements to support their health or physical pursuits, but the specific dietary and supplement practices of CrossFit® participants remain unknown.MethodsAn electronic questionnaire was developed to collect data on practice of popular diets (i.e. Paleo and The Zone Diet®), dietary and sports supplement use, reasons for practicing a diet or using supplements, sources of information on diets and supplements, and various beliefs associated with nutrition among CrossFit® participants.ResultsOf the 2,576 complete responses (female 51.9%, male 48.1%, age 39.4 ± 11.1 years, body mass index 26.1 ± 3.9 kg/m2), 695 (27%) reported being a CrossFit® trainer or coach and 1,392 (54%) reported competing, or planning to compete, in CrossFit® or other fitness competitions. The average years of CrossFit® experience were 5.3 ± 3.1 years, and the average frequency of CrossFit® participation was 4.5 ± 1.1 days/week. Most participants (60.1%) reported practicing a particular diet. Macro Counting (18.6%), Intermittent Fasting (7.7%), and Paleo (6.1%) were the most frequently reported diets. The top reasons for practicing a diet were to improve overall health (45.6%), decrease body fat (29.2%), and improve CrossFit® performance (25.2%). The top sources of dietary information were the Internet (47.5%), coach/trainer (28.7%), and nutritionist/dietitian (26.2%). Most participants (67.3%) reported "Urine Color" as the best method to assess hydration. Additionally, most participants (82.2%) consumed at least one supplement, with protein (51.2%), creatine (22.9%), and pre-workout/energy (20.7%) being most popular. The top reasons for consuming supplements were to improve recovery (52.6%), improve overall health (51.4%), and increase muscle mass/strength (41.7%). The top sources of information on supplements were the Internet (53.1%), coach/trainer (27.0%), and peer-reviewed research (23.0%).ConclusionsA large proportion of CrossFit® participants may practice popular diets or consume supplements with the intention of improving health or performance. These findings may support future research on the effects of various dietary patterns and supplements on CrossFit® performance.

Dataset Information

Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring.

Publications

Best Practices for Dietary Supplement Assessment and Estimation of Total Usual Nutrient Intakes in Population-Level Research and Monitoring.

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