Sponsored by the Campaign for Essential Nutrients
Part 1 of this series described the debate over the role vitamin and mineral supplements (VMS) may play in reducing the risks for various chronic diseases and how many health care professionals and consumers may have lost sight of the main function of vitamins and minerals as essential nutrients. Here in Part 2, we examine the basis for the Dietary Reference Intakes (DRIs), specific functions of the “gap” nutrients and the possible health consequences of insufficient intakes.
In the past, the recommended nutrient intakes from the Institute of Medicine (IOM) [the Recommended Dietary Allowances (RDA) in the United States and Recommended Nutrient Intakes (RNI) values in Canada] focused primarily on preventing nutritional deficiencies. In 1994, the scope changed and went beyond just reducing the incidence of diseases of nutritional deficiency to helping individuals optimize their health, prevent disease, and avoid consuming too much of a nutrient.1 These new nutrient intake recommendations are called Dietary Reference Intakes, or DRIs, which include:1
An analysis of 2007-2010 data from the National Health and Nutrition Examination Survey (NHANES) of more than 16,000 Americans 4 or more years of age showed that up to 90% obtained less than the EAR for one or more vitamins and minerals from foods alone (i.e., did not take vitamin or mineral supplements) (See Figure).2
Additionally, while less than 10% of the overall U.S. population has nutrition deficiencies, the prevalence of deficiencies varies considerably by age, gender, or race/ethnicity and is as high as nearly one third of certain population groups. The following are several examples from the Center for Disease Control’s (CDC) Second National Report on Biochemical Indicators of Diet and Nutrition:3
Research has proven that vitamins and minerals play a critical role in supporting health, including major discoveries of their roles in preventing rare, but serious vitamin deficiency diseases in the U.S.
The functions of other nutrients low in many Americans’ diets (Figure) are shown in the Table below.
* The scientific/medical literature is inconsistent in defining vitamin D deficiency. Here “severe vitamin D deficiency” is defined as a 25-hydroxyvitamin D serum level < 30 nmol/L; the cut-off used by the Institute of Medicine (IOM) as the criterion for increased risk for rickets. However, the IOM also defined < 50 nmol/L as “insufficient” to maintain bone health, and some scientific reports interpret values below this cut-off as ‘deficient.’ Based on a 50 nmol/L cutoff, the CDC report shows that nearly 90 million Americans (31.7%) have vitamin D deficiency/insufficiency, with higher rates in Non-Hispanic blacks (70.6%) and Mexican-Americans (44.2%).3
Additional research is needed to determine the long-term health impact of low vitamin and mineral intakes. On the other hand, the nutritional functions and required intake levels of vitamins and minerals are well established, and there is no evidence that supplements providing approximately 100% of the recommended levels of vitamins and minerals are harmful. Given the evidence, VMS can be recommended as a reasonable way, in conjunction with improving diet quality, to help many Americans get adequate amounts of vitamins and minerals.
The Campaign for Essential Nutrients is comprised of Bayer HealthCare LLC, DSM Nutritional Products, PHARMAVITE LLC. and Pfizer Inc.
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