Considerations for Secondary Prevention of Nutritional Deficiencies in High-Risk Groups in High-Income Countries

Abstract

Surveys in high-income countries show that inadequacies and deficiencies can be common for some nutrients, particularly in vulnerable subgroups of the population. Inadequate intakes, high requirements for rapid growth and development, or age- or disease-related impairments in nutrient intake, digestion, absorption, or increased nutrient losses can lead to micronutrient deficiencies. The consequent subclinical conditions are difficult to recognize if not screened for and often go unnoticed. Nutrient deficiencies can be persistent despite primary nutrition interventions that are aimed at improving dietary intakes. Secondary prevention that targets groups at high risk of inadequacy or deficiency, such as in the primary care setting, can be a useful complementary approach to address persistent nutritional gaps. However, this strategy is often underestimated and overlooked as potentially cost-effective means to prevent future health care costs and to improve the health and quality of life of individuals. In this paper, the authors discuss key appraisal criteria to consider when evaluating the benefits and disadvantages of a secondary prevention of nutrient deficiencies through screening.

Keywords: biomarkers; cost-effectiveness; nutrient inadequacies and deficiencies; nutrition screening; nutritional supplements; public health.

Figure 1

Proportion of inadequate macronutrient intakes by age, gender and life stage categories based on percentage of the US population with intakes below the Estimated Average Requirement (EAR) (protein) or adequate intake (fiber, 18:3 PUFA). From National Health and Nutrition Examination Survey (NHANES) 2007–2010). Inadequate intakes: black: >80%, red: 40–80%, yellow: 20–40%, and green: <20% below EAR or adequate intake.

Figure 2

Proportion of inadequate intakes of water-soluble vitamins by age, gender and life stage categories based on percentage of the US population with intakes below the EAR. From NHANES 2007–2010). Inadequate intakes: black: >80%, red: 40–80%, yellow: 20–40%, and green: <20% below EAR.

Figure 3

Proportion of inadequate intakes of fat-soluble vitamins by age, gender and life stage categories based on percentage of the US population with intakes below the EAR (vitamins A, D, and E) or adequate intake (vitamin K). From NHANES 2007–2010). Inadequate intakes: black: >80%, red: 40–80%, yellow: 20–40%, and green: <20% below EAR or adequate intake.

Figure 4

Proportion of inadequate intakes of minerals by age, gender and life stage categories based on percentage of the US population with intakes below the EAR (calcium, phosphorus, magnesium, iron, zinc, copper, selenium) or adequate intake (potassium). From NHANES 2007–2010). Inadequate intakes: black: >80%, red: 40–80%, yellow: 20–40%, and green: <20% below EAR or adequate intake.

Figure 5

Risk of deficiency by age, gender and life stage categories for individual vitamins or anemia, based on percentage of the population aged >9 years with biomarkers below the deficiency cut-off values (vitamin B6, folate, B12, A, C, D, E, and anemia; pyridoxal 5′-phosphate <20 nmol/L; serum folate <2 ng/mL or red blood cell folate <95 ng/mL; vitamin B12 <200 pg/mL or methylmalonic acid >0.271 µmol/L; serum retinol <20 µg/dL; vitamin C <0.2 mg/dL; 25-hydroxyvitamin D <12 ng/mL; α-Tocopherol <500 µg/dL; mean corpuscular volume <95 fL, respectively). Deficient status: black: >9%, red: 6–9%, yellow: 3–6%, and green: <3% below the cut-off value for deficiency. Based on NHANES data 2003–2006.

Figure 6

Initial qualitative risk-benefit assessment and subsequent quantitative cost-effectiveness analysis of nutrient supplementation of high-risk groups.