Filling the gaps on ‘Nutrients of Concern’

Family Eating

Featured article in the Fall 2016 Issue of Nutrition Close-Up; written by Stacey Mattinson, RDN, LD

On January 7, 2016 the United States Department of Agriculture (USDA) and Department of Health and Human Services (HHS) jointly released the 2015-2020 Dietary Guidelines for Americans (DGA). These guidelines, updated every five years since 1980, provide guidance for health professionals and lawmakers on what constitutes a healthful dietary pattern, contrasts dietary and physical activity guidelines with current actual behaviors, and outlines a vision for the prevention of chronic diseases.1 Included within the DGA are nutrients of concern.

Nutrients of Concern
Nutrients of concern include those underconsumed when compared to the Dietary Reference Intakes, including the Estimated Average Requirements (EAR) or Adequate Intakes (AI); and overconsumed compared to Tolerable Upper Intake Levels (UL) or other expert standards when an UL is unestablished.1.2 Nutrients of concern as noted by the Dietary Guidelines Advisory Council (DGAC) pose particular public health risk. Chasms between national guidelines and intake were identified in the integrated federal food survey “What We Eat in America,” the dietary component of the National Health and Nutrition Examination Survey (NHANES). The intent and purpose of identifying nutrients of underconsumption and overconsumption is to reduce chronic disease risk and assist in meeting individual nutrient needs among Americans. With approximately 17% of American children (ages 2-19 years of age) and 35% of American adults categorized as obese, it may be difficult for some to imagine the idea of “undernutrition” in America.3,4 But nutrients commonly underconsumed in the U.S. include calcium, magnesium, potassium, choline, dietary fiber, and vitamins A, D, E, and C.1,2 Iron is often underconsumed by females in adolescent years, while pregnant, or premenopausal.1,2 The DGAC suggests that undernutrition of the aforementioned nutrients primarily occurs in the context of an overall poor dietary pattern with particularly limited intake of fruits, vegetables, whole grains and dairy.1.2 A more accurate assessment, perhaps, would be to describe the population of the U.S. as largely overfed but undernourished. Nutrients of concern for overconsumption are saturated fat and sodium.2 It is recommended that saturated fats be reduced and replaced with mono- and polyunsaturated fats to reduce blood lipids and cardiovascular disease risk. Examples include cooking with plant oils, using nuts and seeds, incorporating fatty fish, and choosing lean meats, poultry, and non- or low-fat dairy. High sodium foods and food preparations may be replaced with lower sodium options and limited added salt in cooking to reduce risk of hypertension and cardiovascular disease.

Where do eggs fit?
Shifting the overall dietary pattern to consume more healthful, nutrient-dense foods is underscored in the latest DGA guidance. As healthcare professionals, our understanding of the nutrient profile of a number of foods is imperative to providing quality care. Eggs are a nutrient powerhouse, providing protein and a number of shortfall micronutrients. One large hard-boiled egg meets 27% and 35% of choline needs for men and women, respectively; 8% and 11% of vitamin A needs for men and women, respectively; 7% of female iron needs; 7% of vitamin D needs; and 4% of vitamin E requirements.5,6 Minor contributions of magnesium and potassium are also made.5 Protein was not identified as a shortfall nutrient by the DGAC, however it was noted that 6% and 11% of men and women, respectively, over 80 years of age did not meet minimum protein requirements.2 In regard to this shortcoming among some older adults, one large hard-boiled egg provides 11% and 14% of minimum protein needs for these men and women, respectively.5,6 Each large egg contains 1.6 grams of saturated fat (or 3.2 grams per 100 gram serving) and is therefore a lean protein by definition, with limited naturally occurring sodium (71 mg per large egg compared to the recommended ≤2300 mg daily).5 Eggs can be recommended with confidence as an excellent source of lean protein and a supplier of several shortfall micronutrients without significant contribution of nutrients of concern for overconsumption.

Conclusion
The DGAC reports that approximately 117 million adults in the U.S., nearly half of the adult population, have one or more preventable chronic diseases, among them cardiovascular disease, type 2 diabetes, some cancers, and overweight or obesity related to poor diet quality and lack of adequate physical inactivity.1 Gleaning from the MyPlate healthful eating pattern, healthcare professionals can encourage diets consistently replete with a variety of fruits, vegetables, whole grains, lean proteins, and non- or low-fat dairy or fortified soymilk, with limited salt, to assist Americans in reducing risk of chronic disease and improve nutritional adequacy. Healthcare professionals should be encouraged to become familiar with nutrient profiles of specific foods to assist clients in meeting shortfall nutrients when dietary intake is lacking.

 

 

Stacey Mattinson, RDN, LD founded Elevate Nutrition Consulting because, she says, “she’s sick of seeing people who are sick.” Stacey, a graduate of Brigham Young University, is currently completing her work toward a Masters of Science in Nutrition at Texas Woman’s University. Stacey’s business approach today is to prevent serious illness before it occurs.

References
1. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 Dietary Guidelines for Americans. 8th Edition. Version current December 2015. Internet: http://health.gov/dietaryguidelines/2015/guidelines/ (accessed 16 August 2016).
2. Office of Disease Prevention and Health Promotion. Scientific Report of the 2015 Dietary Guidelines Advisory Committee, Part D: Chapter 1: Food and Nutrient Intakes and Health: Current Status and Trends. Internet: https://health.gov/dietaryguidelines/2015-scientific-report/06-chapter-1/default.asp (accessed 18 July 2016).
3. Centers for Disease Control and Prevention. Adult Obesity Facts. Version current 21 September 2015. Internet: https://www.cdc.gov/obesity/data/adult.html (accessed 16 August 2016).
4. Centers for Disease Control and Prevention. Adult Obesity Facts. Version current 19 June 2015. Internet: https://www.cdc.gov/obesity/data/childhood.html (accessed 16 August 2016).
5. United States Department of Agriculture Agricultural Research Service. Basic report:01129, egg, whole, cooked, hard-boiled. Version current 2016 May. Internet: https://ndb.nal.usda.gov/ndb/foods/show/118?fgcd=&manu=&lfacet=&format=&count=&max=35&offset=&sort=&qlookup=hard+boiled (accessed 20 August 2016).
6. United States Department of Agriculture National Agricultural Library. Dietary Reference Intakes: Estimated Average Requirements, Recommended Intakes, Acceptable Macronutrient Distribution Ranges, and Tolerable Upper Intake Levels. Version current 2011. Internet: https://fnic.nal.usda.gov/sites/fnic.nal.usda.gov/files/uploads/recommended_intakes_individuals.pdf (accessed 23 February 2016).

 

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