Strategies for improving nutrient intake considering both 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.

Upcoming

A new activity proposal is under consideration to investigate whether updated Upper Limits (UL) of intake for micronutrients could be derived specifically for infants and young children based on new safety studies.
During the next meeting the task force will agree on the new priorities.

What’s New

The new publication on ‘Dietary Fibre in Europe: Current State of Knowledge on Definitions, Sources, Recommendations, Intakes and Relationships to Health’ has been published in Nutrition Research Reviews (A.M. Stephen et al., 2017).
The new ‘Systematic Review on N-3 and N-6 PUFA Intake in European Countries in Light of the Current Recommendations – Focus on Specific Population Groups’ has been published in Annals of Nutrition and Metabolism (I. Sioen et al., 2017).

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 in both the general population and specific population groups.

Impact

  • This task force provides understanding of both the health and safety implications of adding nutrients to foods. In addition, it provides critical reviews on current intakes in Europe for example of iodine and fibres (A.M. Stephen et al., 2017).
  • This task force takes the expert groups one step further by initiating multi-phase activities. The activity on omega-3 and omega-6 polyunsaturated fatty acids (I. Sioen et al., 2017) not only tackles the adequacy of intake but also the relevance of indexes and ratio’s and the health effects of arachidonic acid in a set of complementary publications.
  • To get state-of-the-art knowledge on the contribution of conventional foods, dietary supplements and fortified foods to the micronutrient intake in elderly Europeans, gain a first insight with A. Berendsen et al., 2016 that focuses on the Dutch elderly population. Ultimately, this project will strive to provide a data-driven insight into potential strategies to improve micronutrient intake or status of elderly people in Europe that do not interfere with their daily dietary habits.
  • 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 recent work on adequacy of omega-3 and omega-6 PUFA intakes in European countries in light of the current recommendations was presented at many major conferences such as the American Oil Chemists’ Society AOCS Nutrition & Health Division (4 May 2016, Salt Lake City, US), the International Society for the Study of Fatty Acids and Lipids (ISSFAL) 2016 (5-9 September 2016, Stellenbosch, South Africa) and at the Nutrition and Growth Conference (2-4 March 2017, Amsterdam, the Netherlands).

For more detailed information, please contact Ms Nevena Hristozova at nhristozova@ilsieurope.be.

Task Force Members


* Scientific Advisor

Expert Groups

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

Objectives
Adequate dietary iodine intake is required for the production of thyroid hormone. The adverse effects of iodine deficiency (ID) – goitre, 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 aim of this activity is to gain a better insight into the magnitude of iodine deficiency in Europe and to explore what further actions are needed and where.

Activity
The objectives are to systematically review current iodine intake in Europe, discuss potential interactions of iodine with other substances and to identify potential needs for fortification. 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. 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. 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.

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 is performing 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 are 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 that 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.

Omega3 and Omega-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 omega-3 and omega-6 PUFA in vulnerable populations is limited or sometimes lacking. This activity has investigated the adequacy of current omega-3 and omega-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. The first publication investigated current intake of total and specific omega-3 and omega-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 omega-3 and omega-6 PUFA. The second publication will describe the relevance of omega-3 and omega-6 PUFA intake indexes and ratios and compare them to absolute intake levels. The third manuscript will systematically review the health effects of arachidonic acid.

Expected Output
This multi-phase project analysed and evaluated omega-3 and omega-6 PUFA intake, highlighting any remaining knowledge gaps. Actions have been proposed where serious gaps between nutrient intake and recommendations were identified. Manuscripts 2 and 3 will tackle the relevance of omega-3 and omega-6 PUFA intake ratios versus absolute amounts and identified knowledge gaps related to health effects of arachidonic acid and the relevance of omega-3 and omega-6 PUFA intake ratios versus absolute amounts.

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 multi-phase 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 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 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. The main outcome of the project would be data-driven insight in potential strategies to improve micronutrient intake or status of elderly people that do not interfere with their daily dietary habits. The final data will give insight in food based solutions to increase micronutrient intake in the elderly population and will give information on the products regularly consumed by elderly in different countries. The outcomes will give a clear picture on the current role of fortified foods and will highlight where food fortification could be used to its full potential.

Adequacy of Dietary Fibre Intake of the European Population with Reference to both Total and Specific Types of Fibre – Completed

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 are identified and need for further research on total and specific types of fibre are also highlighted. The expert group’s manuscript has been published in Nutrition Research Reviews.(A. Stephen et al., 2017)

Expert Group Members

Intake and Sources of Iodine in European Countries

Interactions of Micronutrients with Other Constituents of the Food Matrix

Omega-3 and Omega-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 – Completed

Publications

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