1. Potential Strategies : There are 3 relatively simple key strategies to help improve nutrient intake: Authors: Victoria Sharp, Toine Hulshof P-181 Reference: Title: POTENTIAL STRATEGIES TO IMPROVE MICRO-NUTRIENT INTAKE IN ADULT WOMEN WITH SUBOPTIMAL VITAMIN AND MINERAL INTAKES AND STATUS Figure 1: Proportion of non-supplement taking adult women in the UK with an average daily intake of micronutrients from food sources, below the LRNI and RNI (Reference Nutrient Intake). 8 Change the daily diet by replacing current food with that of higher nutrient density. This is the most natural route as it doesn’t involve supplementing the diet or consuming fortified products; and therefore the risk of overconsumption is very low. 4 In the example of iron, there is evidence that higher consumption of foods naturally rich in iron leads to increased intakes and improved iron status, however this requires an initial change in eating behaviour. 4 The bioavailability of micronutrients is important in determining how much of the intake is available for the body. Factors that will affect this should be considered when altering the diet to improve micronutrient status. For example, iron absorption can vary from 1% to 40% depending on other dietary factors. Some of these factors are outlined in Table 1. Although this is often referred to as the most sustainable approach, there may be some constraints to this strategy. 7 For example, economic constraints may contribute to unhealthy food choices resulting in suboptimal micronutrient intakes and some sub groups of this population aren’t often considered in advice. 6 For example, women who are following a vegan diet and would therefore avoid any product of animal origin. Increase the amount of foods in the diet with added vitamins and minerals. This strategy reaches a large proportion of the population whilst requiring no or very little action on the consumers part. 3 Although consumers don’t need to change their habitual dietary patterns, strong and impactful advertising and labelling may be needed from manufacturers or governments to highlight fortified foods to consumers. 3 In order to be successful with consumers, fortified foods need to be the same price as comparable foods as well as tasting the same. 3 Fortification, especially mandatory fortification, will on the other side capture people who don’t necessarily need or want it. Use of micro-nutrient supplements in addition to the normal diet. Iron supplementation is an effective strategy to improve the iron intake of an individual and is particularly effective at targeting specific groups in need, such as pregnant women or vegans. 7 However, the NDNS reports that supplement takers in all age and sex groups had a higher mean intakes of all minerals from food sources compared with non- supplement takers. 1 This suggests that individuals who really need supplements are often the ones not taking them. Studies have also shown that even during times when supplements have proven to be beneficial, for example folic acid supplements during pregnancy, women in the UK continue with their established behaviours and are reluctant to adapt when it requires effort, money or doing something unfamiliar. 3 Due to the relatively high levels of the micro-nutrients in supplements, it has the highest risk for overconsumption of certain vitamins and minerals. Enhancing FactorsInhibiting Factors Lean red meat (haem iron)*. Calcium, particularly from milk and dairy products. Oily fish, such as salmon and sardines. Phytates, present mainly in cereal bran, grains, legumes, nuts and seeds. Vitamin C, for example fresh fruit and juices. Iron-binding phenolic compounds (polyphenols, tannins), which are present in tea, coffee, herbal infusions and leafy green vegetables. Fermented products, such as soy sauce and bread (reduce the effect of phytates). The National Diet and Nutrition Survey (NDNS) 2008 – 2012, is designed to assess the diet, nutrient intake and nutritional status of the general population aged 1.5 years and over living in private households in the UK. 1 Figure 1, shows that there are a significant proportion of adult women (19-64 years old) in the UK, whose average daily intake of some micro-nutrients is below the Lower Reference Nutrient Intake (LRNI). The LRNI is the value that only provides sufficient intake for 2.5% of the population. If the percentage of people below the LRNI is larger than 5%, this is considered a micronutrient of concern. In this population micronutrients of concern include iron, calcium, magnesium, vitamin D and riboflavin as shown in Figure 1. There are no current global figures for iron deficiency, but using anaemia as an indirect indicator it can be estimated that most preschool children and pregnant women in non-industrialised countries, and at least 30-40% in industrialised countries, are suboptimal or deficient in iron. 2 There are however, several strategies available to improve micronutrient intake. Table 1: Dietary factors that can potentially enhance or inhibit iron absorption. 4 Conclusions  All of the 3 strategies can have a positive impact on micro-nutrient intake but the effectiveness of one, or a combination of these approaches, may depend on which micronutrient status needs to be improved.  Lifestyle and other dietary factors need to be taken into consideration when looking at the most effective strategy.  Different strategies are needed on an individual and population level; on an individual level it might be most effective to use a combination of strategies. However, from a public health perspective fortification seems to be the cheapest and most effective strategy.  Supplementation is a valuable option for ensuring that vulnerable subgroups, such as vegans and pregnant women, can meet the RNI. References: 1.Bates et al (2014) National Diet and Nutrition Survey. Results from Years 1-4 (combined) of the Rolling Programme (2008/2009 – 2011/12) 2.World Health Organisation (2001) Iron Deficiency Anaemia – Assessment, Prevention and Control. 3.Tedstone, A. et al (2007) Fortification of selected foodstuffs with folic acid in the UK: consumer research carried out to inform policy recommendations. Journal of Public Health. 30 (1) 23 – 29. 4.Derbyshire, E (2010) Iron deficiency anaemia in pregnancy – what are the solutions? Nutrition and Food Science. 40 (6) 598 – 607. 5.Rickard AP. et al (2009) An algorithm to assess intestinal iron availability for use in dietary surveys. British Journal of Nutrition. 102 (11) 1678-1685. 6.Darmon, N. et al. (2002) A cost constraint alone has adverse effects on food selection and nutrient density: An analysis of human diets by linear programming. The Journal of Nutrition. 132 (1) 3764 – 3771. 7.Gautam, C. et al. (2008) Iron deficiency in pregnancy and the rationality of iron supplements prescribed during pregnancy. The Medscape Journal of Medicine. 10 (12) 283. 8.DE VRIES, J. (2016) Personal information. The Problem : *Iron is generally better absorbed when consumed from meat rather than plant-based food sources. 4