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Describe and evaluate nutrients of public health concern.

Approach to Answering the Question
Data Analysis

Data Analysis and Food Pattern Modeling Cross-Cutting Working Group

Data Analysis Protocol
Developed for each scientific question being examined, the protocol describes the plan for how the data analysis will be conducted. The protocol provides the: 

  • Analytic framework, 
  • Analytic plan, and 
  • Analysis results. 

For this question, a three pronged approach will be used to determine nutrients of public health concern:

1. Estimate prevalence of inadequate and excessive nutrient intakes by comparing current distribution of nutrient intakes in the U.S. population to Dietary Reference Intakes published by the National Academies of Sciences.

Nutrient intakes from food and beverages alone as well as the additional contribution of nutrient from intakes of dietary supplements. 

  • For nutrients with an Estimated Average Requirement (EAR), the estimated prevalence of inadequate intakes will be determined using the EAR cut-point method for nutrients with an EAR.  Iron in menstruating women will be evaluated with the probability approach.
  • For nutrients with an Adequate Intake (AI), mean nutrient intakes will be compared to the AI to determine the estimated prevalence above the AI.
  • For nutrients with a Tolerable Upper Intake Level (UL) or Chronic Disease Risk Reduction (CDRR) intake, the estimated prevalence of potentially excessive intakes will be determined by examining the percent of the population with intakes above the UL or CDRR. 
  • For nutrients with an Acceptable Macronutrient Distribution Range (AMDR), the estimated prevalence of the population with intakes outside of the range will be evaluated. 
  • Percent energy contributed from added sugars and saturated fat will be compared to the 2015-2020 Dietary Guidelines for Americans recommendations of <10% of total energy from each nutrient.

2. When available, consider biological endpoints or validated surrogate endpoints such as biochemical indices of nutrient status with valid cut-points in addition to dietary intakes of nutrients.

3. Consider scientific evidence on the relationship between nutrient inadequacy or excess and clinical health consequences (e.g. cardiovascular disease, cancer).

Note: The analytic plan for infants and toddlers is still in development. The analytic plan for ages 2+ is being implemented. 

For additional details, see the full protocol for the question, describe and evaluate nutrients of public health concern.

View Full Protocol

Draft Conclusion Statement

The draft conclusion statements listed below describe the state of the science related to the specific question examined. Draft conclusions are not considered final until they have been deliberated with and decided upon by the full Committee and published in the Committee’s final advisory report. Individual conclusion statements should not be interpreted as dietary guidance or the Committee’s overarching advice to the Departments.

Food Components of Public Health Concern for Ages 1 and Older

For the population of Americans ages 1 year and older, dietary intake distributions, along with biological endpoints and prevalence of related clinical outcomes, suggest that vitamin D, calcium, dietary fiber, and potassium are underconsumed, and sodium, saturated fat, and added sugars are overconsumed and are of public health concern for all Americans. 

Life-Stage Specific Concerns

Toddlers (12 to less than 24 months) have food components of public health concern due to underconsumption including potassium, dietary fiber, and vitamin D. Sodium and added sugars are overconsumed by toddlers, which is also of concern. 

Based on dietary intake data and serum ferritin levels, iron is of public health concern among older infants fed human milk (77%, 6 to less than 12 months), adolescent females (20%, ages 12 to 19 years), and premenopausal females (16%, ages 20 to 49 years). 

Food components of public health concern among pregnant or lactating women are the same as those of non-pregnant and non-lactating women with some additions. Among pregnant women, iron and iodine are also of public health concern, based on biomarker data that suggest low nutrient status.

Given the high prevalence of inadequate folic acid intakes observed in pregnant women, and that nutrient’s critical relationship to risk of neural tube defects, folate/folic acid should remain of concern among pregnant women in the first trimester of pregnancy when the neural tube is formed and closed. Folate status appears to be adequate based on biomarker data in non-pregnant, non-lactating women.

Food Components that Pose Special Public Health Challenges 

The following food components are underconsumed for all Americans 1 year and older but do not appear to pose a public health concern given the present lack of adverse clinical and health outcome data: vitamins A, C, E, and K; magnesium, and choline.

Certain life-stages have specific food components that may pose public health challenges. 

Proposed nutrients or food components that pose public health challenges for all infants, based on low estimated mean nutrient intakes compared to adequate intakes expected from complimentary foods and beverages, include potassium, vitamin D, and choline. 

Dietary intake data among human milk fed infants which capture human milk feeding and complementary foods and beverages suggest that iron, zinc, and protein intakes fall below the estimated average requirements for infants ages 6 to less than 12 months. 

Nutrients that pose public health challenges for formula-fed infants, with elevated mean intakes from formula and complementary foods compared to adequate intakes, include retinol and zinc. High intakes of these nutrients have not been linked to adverse health outcomes, so they are not considered nutrients of public health concern; however, they do warrant on-going surveillance.

Nutrients or food components that pose public health challenges for toddlers between the ages of 12 and 24 months include choline and linoleic acid, given that dietary intakes do not approximate recommendations.

Young children ages 1 to 3 years overconsume retinol, zinc, selenium, and copper relative to the Dietary Reference Intakes. High intakes of these nutrients have not been linked directly to adverse health outcomes, so they are not considered nutrients of public health concern; however, they do warrant on-going surveillance.

Adolescents (ages 9 to 14 years) have a constellation of potential nutritional risk factors that are considered a public health challenge. Girls have low intakes from foods and beverages of protein, folate, vitamin B6, and vitamin B12, and girls and boys have low intakes of phosphorus, magnesium, and choline.

Older adults may be at risk for low intakes and resulting poor nutritional status related to protein and vitamin B12. 

Choline and magnesium are underconsumed in the diets of pregnant and lactating women and should be considered for further evaluation given limited availability of biomarker, clinical, or health outcome data.

With the use of dietary supplements, some pregnant women have high intakes of folic acid and iron; but, without supplements these women would be as risk for inadequacy. With the use of supplements, some lactating women are exceeding recommendations for iron and folic acid. Given that these high intakes have not been directly linked with clinical outcomes, there are not designated of public health concern.