Nutritional gaps in American children based on a 2021 NHANES analysis

Key Take Outs

Does nutritional intake in children vary according to ethnicity?
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Why are deficiencies still appearing despite adequate micronutrient intake?
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Considerations for dietary counseling
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01Does nutritional intake in children vary according to ethnicity?
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02Why are deficiencies still appearing despite adequate micronutrient intake?
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03Considerations for dietary counseling
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Ariana D. Bailey, PhD & Ashley C. Patterson, PhD

An analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2001-2016 highlighted the need for dietary counseling or guidance strategies to address nutritional gaps in American children across different demographic groups.1 Crucially, the analysis highlights the importance of personalizing nutrition and for factors such as age and ethnicity to be taken into account when considering dietary counseling or guidance.1

Nutritional gaps

Among children 1-6 years of age, iron deficiency and inadequate intakes of fiber, calcium, choline, potassium, docosahexaenoic acid (DHA), and vitamins D and E were identified as of concern.

Table 1. The nutrients of concern for 1-6 years based on the analysis of NHANES 2001-2016 were:

Nutrient	% of population with intake <EAR¹	% of population with intake >AI¹
Vitamin D	86.6
Vitamin E	69.2
Calcium	16.8
Choline		39.7
Potassium		37.8
Fiber		0.60

EAR: Estimated Average Requirement (a nutrient intake value that is estimated to meet the requirement of half the healthy individuals in a group). AI: Adequate Intake (a value based on observed or experimentally determined approximations of nutrient intake by a group [or groups] of healthy people).²

These findings were supported by previous analysis of the Feeding Infants and Toddlers Study (FITS) (2016) which concluded that concern also exists over low intakes of iron, potassium, vitamin D and fiber.^3,4 Analysis of NHANES also found that the proportion of children not meeting recommended intakes for vitamin D, calcium, fiber, choline and potassium increased with age.¹ Evidence suggests that a significant portion of the population do not meet recommendations for these key nutrients even when supplement use is taken into consideration.³

Table 2. Proportion of children 1-6 years of age below EAR by Age Group

Nutrient	% of population with intake below EAR¹
	Age 1-3	Age 4-6
Vitamin D	82.7	90.8
Calcium	3.6	30.4

Table 3. Proportion of children 1-6 years above AI by Age Group

Nutrient	% of population with intake above AI¹
	Age 1-3	Age 4-6
Choline	51.7	27.1
Potassium	45.1	30.1
Fiber	1.0	0.2

For more information see our downloadable infographic on Sources of Fiber

DHA intake was also universally low in all children evaluated, despite the importance of DHA for brain development during early life.^1,5

Table 4. Percentage of 1-6 years of age below expert recommendations for DHA intake

Age	% population below expert recommendations for DHA intake^1,6,7
	<70 mg/d	<100 mg/d
1-2 y	97.6	99.3
2-3 y	97.6	99.3
4-6 y	97.3	99.2
1-6 y	97.4	99.3

Does nutritional intake in children vary according to ethnicity?

Importantly, different ethnic groups had varied intakes, and some children were more likely to have inadequate nutrient intake than others. For example, inadequate calcium intake was notably higher among Non-Hispanic Black children compared with Non-Hispanic White and Hispanic children.

Table 5. Proportion of children 1–6 years not meeting EAR by Ethnicity

Micronutrient	% of study population with intake below the EAR¹
	Non-Hispanic White	Non-Hispanic Black	Black	Asian
Vitamin D	90.4	94.9	88.5	80
Vitamin E	53.2	40.1	60.8	48.2
Calcium	14.3	26	12.5	16.5

Why are deficiencies still appearing despite adequate micronutrient intake?

Adequate or inadequate micronutrient intake did not necessarily translate directly into deficiencies. Markers of iron and vitamin B6 deficiencies were found despite adequate intake of both micronutrients among the majority of the study population.1

Check out our quick reminder article on micronutrient inadequacy vs. deficiency.

Considerations for dietary counseling

The analysis highlights the importance of personalizing nutrition to individuals and for factors such as age and ethnic group to be taken into account when considering dietary intervention strategies.1 Other factors should also be considered, including poverty level and markers of nutrient deficiencies even when nutrient intake may be judged to be adequate.1

The full study and results can be accessed at: https://doi.org/10.3390/nu13030827.

Bailey AD, Fulgoni VL III, Shah N, Patterson AC, Gutierrez-Orozco F, Mathews RS, Walsh KR. Nutrient intake adequacy from food and beverage intake of US children Aged 1–6 years from NHANES 2001–2016. Nutrients 2021, 13: 827. https://doi.org/10.3390/nu13030827
Institute of Medicine (US) Food and Nutrition Board. Dietary Reference Intakes: A risk assessment model for establishing upper intake levels for nutrients. Washington (DC): National Academies Press (US); 1998. https://www.ncbi.nlm.nih.gov/books/NBK45182/
Bailey RL, Catellier DJ, Jun S, Dwyer JT, Jacquier EF, Anater AS, Eldridge AL. Total usual nutrient intakes of US children (under 48 months): Findings from the feeding infants and toddlers study (FITS) 2016. J Nutr 2018, 3:148. https://doi.org/10.1093/jn/nxy042
Anater AS, Catellier DJ, Levine BA, Krotki KP, Jacquier EF, Eldridge AL, Bronstein KE, Harnack LJ, Peasley JM, Lutes AC. The feeding infants and toddlers study (FITS) 2016: study design and methods. J Nutr 2018, 148:1516S–24S. https://doi.org/10.1093/jn/nxy159
Thompson M, Hein N, Hanson C, Smith LM, Anderson-Berry A, Richter CK, Bisselou KS, Appiah AK, Kris-Etheron P, Skulas-Ray AC, Nordgren TM. Omega-3 fatty acid intake by age, gender, and pregnancy status in the United States: National health and nutrition examination survey 2003-2014. Nutrients 2019, 11(1):177. https://doi.org/10.3390/nu11010177
AFSSA (France). Opinion of the French Food Safety Agency on the update of French population reference intakes (ANCs) for fatty acids. AFFSA-Request No. 2006-SA-0359. [Internet; cited 2024 May 10]. Available from: https://www.anses.fr/en/system/files/NUT2006sa0359EN.pdf
EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). Scientific Opinion on Dietary Reference Values for Fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA J 2010, 8:1461. https://doi.org/10.2903/j.efsa.2010.1461