Strategies for improving nutrient intake considering risks and benefits

Background

Today, understanding and assessing adequate nutrient intake and safe food fortification present major challenges in Europe. Therefore, the Nutrient Intake Optimisation Task Force addresses scientific approaches to explore how to better estimate nutrient intake and status. The task force also explores how intake of nutrients can be optimised to provide an adequate balance between adequacy and safety, with a focus on vulnerable population groups.

Objectives

The scope of the task force encompasses the analysis of knowledge gaps between dietary requirements, intake, status and recommendations. Going further, it also assesses the health risks / benefits of adding macronutrients, micronutrients and specific food substances to foods. The resulting reviews will provide guidance on how to improve, for example, food fortification practices in Europe in order to optimise nutrient intake without compromising the safety for consumers. The task force will use integrated approaches, taking into account both nutritional needs / benefits as well as risks / safety aspects.

Impact

  • The task force has put forward methods for estimating the changes in micronutrient intake over time, from all dietary sources (E. Casala et al., 2014).
  • The task force shed light on the prevalence of intakes below the Recommended Daily Allowance (RDA) within Europe (G. Mensink et al., 2013).

What’s New

  • A new activity on reviewing current iodine intake has been started. The review will focus on intakes, recommendations and status and will evaluate the iodine content of main food sources. It aims to gain better insight into the magnitude of iodine deficiency in Europe and to explore whether further action would be needed and where.
  • New publication in Annals of Nutrition and Metabolism providing a systematic review on intakes of n-3 and n-6 Polyunsaturated Fatty Acids in the European at risk population groups and a comparison to the current dietary recommendations (I. Sioen et al., 2017).
  • New publication in Nutrition Reviews on the contribution of conventional foods, dietary supplements and fortified foods to the micronutrient intake in Dutch elderly participating in the NU-AGE Study (A. Berendsen et al., 2016).
  • A new activity proposal is under consideration to investigate whether Recommended Daily Allowances (RDA) and Upper Limits (UL) should be updated based on adverse health effects associated with higher dosages. Nutrient interactions will also be considered.

For more detailed information, please contact Ms Lilou van Lieshout at lvanlieshout@ilsieurope.be.

Task Force Members

Expert Groups

Intake and Sources of Iodine in European Countries and the Potential Impact of Planned Salt Reduction Strategies on Iodine Intake – NEW

Objectives

Adequate dietary iodine intake is required for the production of thyroid hormone. The adverse effects of iodine deficiency (ID) – goiter, cretinism, intellectual impairments, growth retardation, neonatal hypothyroidism and increased pregnancy loss and infant mortality – are well known and easily corrected with salt iodisation. However, worldwide, more than two billion people are still at risk of iodine deficiency, which impairs health and socioeconomic development. The objectives are to systematically review current iodine intake in Europe, potential interactions of iodine with other substances and to identify potential needs for fortification.

Activity


The aim of this activity is to get a better insight of the magnitude of iodine deficiency in Europe and to explore what further actions are needed and where. The iodine content of main food sources in different European countries will be investigated and intake will be related to current rates of iodine deficiency. The focus will not only be on the general population but also on high-risk populations, particularly children and women in the reproductive age. On one hand, the food industry is strongly encouraged to use iodised salt. On the other hand, in many European countries, health authorities are now recommending salt reduction. Strategies and legislation vary between countries; therefore, this expert group will also provide a comparison of legislations. The expert group will highlight gaps in knowledge between the current consumption of iodine and the recommended amounts and suggest potential actions for filling these gaps.

Expected Output

Iodine deficiency and policy for iodine fortification are topics of current debate. By mapping the iodine issues, this expert group will propose concrete actions, e.g. the need for revising iodisation strategies, increasing sodium in crops via biofortification and exploring other vehicles for fortification besides salt. By highlighting new emerging scientific insights related to iodine intake and by examining their relationship with current intake and recommendations, this activity aims to support future developments and targeted recommendations.

Interactions of Micronutrients with Other Constituents of the Food Matrix

Objectives

The potential interaction of micronutrients with substances in the food matrix plays a role in both bioaccessibility and bioavailability, thereby influencing the efficacy of fortification of food with micronutrients. This is of particular importance for infants and young children. An insufficient or excessive intake might have more health consequences for these groups than for other populations, since they rely on less diverse dietary sources. The aim of this activity is to assess the different methodological approaches to study these interactions, leading to a harmonised framework.

Activity

This expert group will perform a systematic review based on case studies in order to develop guidelines on how to generate and assess scientific information on the effects of food ingredients or food matrix on the bioaccessibility and bioavailability of micronutrients. To assess the methodologies, reviews on iron, zinc and calcium will be conducted. The aim is to identify, for these case studies, interactions with other substances of the food matrix and to investigate the possibility of creating a more generalised framework.

Expected Output

The experts will create a framework of methods to assess micronutrient bioaccessibility and bioavailability and it will be tested and evaluated for simple food matrices in infant formula and infant / child foods. The work will help in formulating additional research hypotheses to cover identified knowledge and methodological gaps.

N-3 and N-6 PUFA Intakes, Ratios and Health Effects

In collaboration with the Early Nutrition and Long-Term Health Task Force.

Objectives

Intake levels of total polyunsaturated fatty acid (PUFA) in adults are available but information on intake of specific n-3 and n-6 PUFA in vulnerable populations is limited or sometimes lacking. This activity has investigated the adequacy of current n-3 and n-6 PUFA intake in several vulnerable target groups, namely infants, children, adolescents, pregnant / lactating women and the elderly by comparing intake data with current recommendations. Based on this review, other knowledge gaps are being identified and addressed.

Activity

This expert group is developing a series of three manuscripts. In the first publication, the expert group investigated current intake of total and specific n-3 and n-6 PUFA in European diets for the identified vulnerable groups (I. Sioen et al., 2017). Along with this, the latest nutritional recommendations and their scientific criteria were examined. In addition, it assessed which foods contributed to the intake of n-3 and n-6 PUFA. In the second publication, the intention is to describe the relevance of n-3 and n-6 PUFA intake indexes and ratios and to compare them to absolute intake levels. In the third manuscript, a systematic review will be performed on health effects of arachidonic acid.

Expected Output

Ultimately, the project will analyse and evaluate n-3 and n-6 PUFA intake, highlighting any remaining knowledge gaps. Actions will be proposed where serious gaps between nutrient intake and recommendations are identified. Manuscripts 2 and 3 will tackle the relevance of n-3 and n-6 PUFA intake ratios versus absolute amounts and identified knowledge gaps related to health effects of arachidonic acid.

Contribution of Dietary Supplements, Nutrient Dense Food and Food Fortification to the Micronutrient Intake and Status of the Elderly

Objectives

The prevalence of malnutrition and undernutrition is high both in institutionalised and non-institutionalised elderly people. Therefore this project intends to generate data that would support the optimisation of dietary guidelines specific for non-institutionalised elderly individuals.

Activity

A pilot database search phase has looked into determining by which ratio the three product categories (i.e. micronutrient-dense food groups, micronutrient-fortified food groups and micronutrient supplements) contribute to the dietary intake or Recommended Daily Allowance (RDA) of elderly Dutch individuals in the highest versus lowest quartile of intake, for selected micronutrients (A. Berendsen et al., 2016). The next phase will determine whether the above calculated contribution to dietary intake is similar in other EU countries. In addition, the advantages and disadvantages of the above-mentioned product categories on the optimisation of dietary micronutrient intake will be investigated. The focus of the activity may shift from vitamins, minerals and trace-elements towards other essential nutrients.

Expected Output

Two sequential manuscripts are expected to be developed. The manuscript of Phase 1 was recently published in Nutrition Research (A. Berendsen et al., 2016). It focuses on the statistical methodology used to assess the relative contribution of each of the three product categories validated in part of the intake database of the EU-funded project ‘New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Ageing in Europe – NU-AGE. The NU-AGE study is performed in several different EU countries: Italy, France, the UK, the Netherlands and Poland. The Phase 2 manuscript will investigate the relative contributions of the three different product categories to the intake of micronutrients and other substances at EU level, and discuss the benefits, advantages and disadvantages of each product category. Dietary guidelines to optimise dietary intake of micronutrients by elderly individuals can be more practically applied by compiling and analysing data on the actual relative contribution of different food categories to the respective RDA.

Adequacy of Dietary Fibre Intake of the European Population with Reference to Both Total and Specific Types of Fibre

Objectives

Intake of total dietary fibre is not optimal in most European countries, in particular in vulnerable groups such as children. Total dietary fibre is important for the maintenance of good overall health and the prevention of chronic diseases, whereas specific fibre types could be recommended for their specific health benefits. The aim of this activity was to analyse specific types of fibre intake across Europe and compare it with current recommendations by reviewing the existing data.

Activity

The expert group reviewed and assessed existing data on recommended and actual intake of total and specific types of fibre in Europe. Data were collected from nutrient-based recommendations and surveys measuring fibre intake directly.

Output

This work resulted in a comprehensive review of the literature on dietary fibre intakes, source recommendations and health effects. Areas where scientific data are lacking were identified and need for further research on total and specific types of fibre was also highlighted. The expert group’s manuscript has been accepted for publication in Nutrition Research Reviews.

Expert Group Members

Intake and Sources of Iodine in European Countries and the Potential Impact of Planned Salt Reduction Strategies on Iodine Intake – NEW

Interactions of Micronutrients with Other Constituents of the Food Matrix – What Could Be the Adverse Health Consequences of Changes in Bioavailability?

N-3 and N-6 PUFA Intakes, Ratios and Health Effects
‘Indexes and Ratios’ Focus Group Members

‘Arachidonic Acid and Health Effects’ Focus Group Members

Contribution of Dietary Supplements, Nutrient Dense Food and Food Fortification to the Micronutrient Intake and Status of the Elderly

Adequacy of Dietary Fibre Intake of the European Population with Reference to Both Total and Specific Types of Fibre

Publications

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