Usual Nutrient Intake Adequacy and Nutritional Status of United States Children and Adolescents: National Health and Nutrition Examination Survey 2001-March 2020.

The study included a representative sample of 32,118 individuals aged 1-18 years from NHANES 2001-March 2020.

• Participants had at least 1 reliable dietary recall
• Pregnant females were excluded
• Dietary intake was collected using 24-h dietary recalls administered via the Automated Multiple Pass Method
• Supplement use was assessed from the 30-day supplement use questionnaire
• All analyses were adjusted to account for the survey design and sampling weights

Inadequate intake of dietary fiber, EPA, DHA, vitamin D, and vitamin E was reported across all age groups of US children and adolescents.

• These nutrients were identified as key nutrients with widespread inadequacy
• Usual macronutrient and micronutrient intake was assessed using the National Cancer Institute method
• Micronutrient intake remained relatively stable across age groups despite increases in needs
• Inadequacies were observed regardless of age group (1-18 years)

Inadequate calcium intake was highly prevalent among adolescent girls, with 78.2% of girls aged 9-18 years reporting inadequate calcium intake.

• Mean (SE) 78.2 (1.3)% of girls aged 9-18 y reported inadequate calcium intake
• Inadequate calcium intake became increasingly common with age
• This pattern was particularly pronounced among adolescent girls
• Calcium was among the nutrients for which inadequacy increased with age alongside magnesium, phosphorus, potassium, and vitamin A

Despite adequate dietary iron intake among younger children, 29.9% of adolescent girls had serum ferritin concentrations indicating iron deficiency.

• 29.9 (1.3)% of adolescent girls had serum ferritin concentrations indicating iron deficiency
• Younger children reported adequate iron intake based on dietary recall data
• The discrepancy between dietary intake adequacy and biomarker status highlights the limitation of dietary intake data alone
• Iron inadequacy was among the nutrients with large proportions of inadequate intake among those aged 9-18 y

Despite adequate dietary folate intake among younger children, 19.7% of adolescent girls had red blood cell folate concentrations below recommended thresholds.

• 19.7 (1.2)% of adolescent girls had red blood cell folate concentrations below recommended thresholds
• Younger children reported adequate folate intake based on dietary recall data
• This finding further illustrates the discrepancy between reported dietary intake and biomarker-based nutritional status

Vitamin D insufficiency increased with age and affected nearly 1 in 5 adolescent girls aged 9-18 years.

• Vitamin D insufficiency was defined as serum 25-hydroxyvitamin D <50 nmol/L
• Nearly 1 in 5 adolescent girls aged 9-18 y had vitamin D insufficiency
• Vitamin D insufficiency increased with age
• Vitamin D was among the nutrients with large proportions of inadequate intake among those aged 9-18 y

Urinary iodine concentration of 20-100 µg/L was prevalent across all age and gender groups.

• Urinary iodine concentration of 20-100 µg/L was found among all ages and gender groups
• This level of urinary iodine concentration was described as prevalent
• Nutrition-related biomarkers were assessed from available NHANES cycles

Inadequate intake of multiple micronutrients including calcium, magnesium, phosphorus, potassium, and vitamin A became increasingly common with age.

• Trends in usual intake across age groups were assessed using linear models
• Differences between groups were assessed using independent samples t tests
• Micronutrient intake remained relatively stable across age groups despite increases in needs
• This stable intake relative to increasing needs was reflected by large proportions of those aged 9-18 y reporting inadequate intakes for vitamin D, vitamin E, calcium, magnesium, and iron