Nutrient Inadequacy Among Nutritionally Vulnerable Populations in the US

Objective

To estimate the prevalence of inadequacy of selected nutrients among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); participants in the Supplemental Nutrition Assistance Program (SNAP); and those with low/very low food security status.

Design

Cross-sectional analysis. The prevalence of nutrient inadequacy among each group was estimated using usual intake methods developed by the National Cancer Institute (NCI). Age- and sex-specific Estimated Average Requirements (EAR), Adequate Intakes (AI), and Tolerable Upper Intake Levels (UL) for each nutrient were used where applicable. Nutrients of interest were fiber, calcium, magnesium, potassium, folate, sodium, and vitamins A, C, and E. Covariates were age, sex, and whether the survey was administered on a weekday (Monday–Thursday) or a weekend (Friday–Sunday). Pooled mean estimates and 95% confidence intervals are presented.

Setting

The National Health and Nutrition Examination Survey (NHANES), 2001–2012.

Subjects

Adults (≥20 y) participating in WIC (N=580), SNAP but not WIC (N=3,128), and adults with low/very low food security, but not participating in WIC or SNAP (N=3,075).

Results

The prevalence of inadequate nutrient intake among WIC participants was greatest for vitamin E (99%, 96%–100%), and fiber (95%, 90–100%), followed by magnesium (62%, 47–77%), vitamin A (54%, 38–70%), vitamin C (41%, 26–56%), and calcium (35%, 19–51%); 0.5% (0–3%) met the AI for potassium and 85% (74–95%) exceeded the UL for sodium. The prevalence of inadequate intake among SNAP participants was highest for fiber (97%, 96–99%) and vitamin E (95%, 92–98%), followed by magnesium (67%, 61–73%), vitamin A (61%, 54–68%), vitamin C (50%, 42–58%), and calcium (48%, 41–55%); 2% (0–3%) met the AI for potassium and 82% (77–87%) exceeded the UL for sodium. Among individuals with low/very low food security, the prevalence of inadequate intake was highest for vitamin E (97%, 94–99%) and fiber (96%, 93–98%), followed by magnesium (64%, 58–71%), vitamin A (64%, 57–71%), calcium (50%, 43–57%), and vitamin C (48%, 40–55%); 1% (0–2%) met the AI for potassium and 84% (79–89%) exceeded the UL for sodium.

Conclusions

Regular assessment of nutrient inadequacy at the population level is a crucial component of the public health nutrition agenda in the US; nutritional monitoring of low income and other vulnerable populations is of particular importance. One the one hand, it is reassuring that populations with a high prevalence of nutrient inadequacy for selected nutrients are participating in federal food assistance programs. Yet, on the other hand, it is clear that most participants in these programs still have nutrient inadequacies. Continued efforts are needed to ensure that nutritionally vulnerable populations have access to healthy foods, and that at-risk individuals are counseled to make food choices that promote nutrition adequacy.

Support or Funding Information

Egg Nutrition Center/American Egg Board and USDA-ARS 3062-51000-051-00D