Hardly anyone is consuming even 400 IU of vitamin D daily – June 2018

Micronutrients in the life cycle: Requirements and sufficient supply

NFS Journal (Nutrition and Food Science)
Biesalski Hans K.a’biesal@uni-hohenheim.de, Tinz Janab
a University of Hohenheim, Institute of Biological Chemistry and Nutrition, Garbenstrasse 30, D-70599 Stuttgart, Germany
b University of Hohenheim, Research Center for Health Sciences, Wollgrasweg 43, D-70599 Stuttgart, Germany

 Download the PDF from VitaminDWiki

Few are getting the ERA (minimum) amount of Magnesium and Vitamin E

Macronutrients (fat, protein, carbohydrates) deliver energy and important material to ensure the entire body composition. Micronutrients are needed to keep this process of continuous construction and re-construction running. Consequently, the requirement for micronutrients will differ depending on the individual need which is related to the different metabolic conditions within the life cycle.
Within the first 1000 days of life, from conception to the end of the second year of life the requirement for micronutrients is high and if the supply is inadequate that might have consequences for physical and at least cognitive development.
In particular, iron, iodine, vitamin D and folate are micronutrients which might become critical during that period. Due to the fact that clinical symptoms of deficiencies develop late, but inadequate supply of one or more micronutrients may have consequences for health the term hidden hunger has been introduced to describe that situation. In particular the time period of pregnancy and early childhood is critical and hidden hunger is a worldwide problem, affecting > 2 billion people, primarily females and children. The importance of different requirements during the life cycle is usually not considered. In addition, we do not really know what the individual requirement is. The estimation of the requirement is based on studies calculating the supply of a micronutrient to avoid a deficiency disease within a healthy population and is not based on sound scientific methodology or data. We need to consider that at different moments in the life cycle the supply might become critical in particular in case of a disease or sudden increase of metabolic turnover. In this narrative review we summarize data from studies dealing with different micronutrient requirements in pregnancy, exercise, vegan diet, adolescents and elderly. Knowledge of critical periods and related critical micronutrients might help to avoid hidden hunger and its consequences.

References

1. Institute of Medicine (IOM), Dietary Reference Intakes, National Academic Press, Washington DC, 2000.
2. EFSA (European Food Safety Authority), Dietary Reference Values for Micronutrients, (2017) (E15121).
3. H.K. Biesalski, P. Grimm, Pocket Atlas of Nutrition, Thieme, New York, 2005.
4. Community Nutrition Mapping Project, USDA Agricultural Research Service. "All U.S.” column, Retrieved 6 November 2014 https://www.nal.usda.gov/fnic/ community-nutrition-mapping-project.
5. H.K. Biesalski, Sustainable micronutrients in Europe: Is there cause for concern? in: H.K. Biesalski, A. Drewnowski, J.T. Dwyer, et al. (Eds.), Sustainable Nutrition in a Changing World, Springer, Heidelberg, 2017.
6. B.R. Vinas, Projected prevalence of inadequate nutrient intakes in Europe, Ann. Nutr. Metab. 59 (2011) 84-95.
7. H.K. Biesalski, Hidden Hunger, Springer, Heidelberg, 2014.
8. H.K. Biesalski, S. Bischoff, C. Puchstein, Ernahrungsmedizin, 5th Edition, Thieme, Stuttgart, 2017.
9. J.J. Cannell, R. Vieth, W. Willett, et al., Cod liver oil, vitamin a toxicity, frequent respiratory infections, and the vitamin D deficiency epidemic, Ann. Otol. Rhinol. Laryngol. 117 (2008) 864-870.
10. L.A. Linday, J.C. Umhau, R.D. Shindledecker, et al., Cod liver oil, the ratio of vitamins A and D, frequent respiratory infections, and vitamin D deficiency in young children in the United States, Ann. Otol. Rhinol. Laryngol. 119 (2010) 64-70.
11. M. Hsiao, C.Y. Hung, K.V. Chang, et al., Is serum hypovitaminosis D associated with chronic widespread pain including fibromyalgia? A meta-analysis of observational studies, Pain Phys. 18 (2015) 877-887.
12. G. Akyuz, C. Sanal-Toprak, I. Yagci, et al., The effect of vitamin D supplementation on pain, quality of life, and nerve conduction studies in women with chronic widespread pain, Int. J. Rehabil. Res. 40 (2017) 76-83.
13. V. Tai, A. Gray, M.J. Bolland, Results of observational studies: analysis of findings from the Nurses' Health Study, PLoS One 9 (2014) e110403.
14. J.M. Geleijnse, C. Vermeer, D.E. Grobbee, et al., Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study, J. Nutr. 134 (2004) 3100-3105.
15. K. Diethelm, N. Jankovic, L.A. Moreno, et al., Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study, Public Health Nutr. 15 (2012) 386-398.
16. NVS-II, https://www.mri.bund.de/de/institute/ernaehrungsverhalten/ forschungsprojekte/nvsii/(26.08.2017, (2008).
17. M. Ferrari, L. Mistura, E. Patterson, et al., Evaluation of iron status in European adolescents through biochemical iron indicators: the HELENA Study, Eur. J. Clin. Nutr. 65 (2011) 340-349.
18. WHO, Guideline: Daily Iron and Folic Acid Supplementation in Pregnant Women, World Health Organization, Geneva, Switzerland, 2012.
19. C. Palacios, L. Gonzales, Is vitamin D deficiency a major global public health problem? J. Steroid Biochem. Mol. Biol. 144 (2013) 138-145.
20. C. Berti, H.K. Biesalski, R. Gartner, et al., Micronutrients in pregnancy: current knowledge and unresolved questions, Clin. Nutr. 30 (2011) 689-701.
21. W. Doyle, A. Srivastava, M.A. Crawford, et al., Inter-pregnancy folate and iron status of women in an inner-city population, Br. J. Nutr. 86 (2001) 81-87.
22. I. Cetin, C. Berti, S. Calabrese, Role of micronutrients in the periconceptional period, Hum. Reprod. Update 16 (2010) 80-95.
23. C. Berti, T. Decsi, F. Dykes, et al., Critical issues in setting micronutrient recommendations for pregnant women: an insight, Matern Child Nutr. 2 (2010) 5-22 (6 Suppl.).
24. H.K. Biesalski, The 1,000-day window and cognitive development, in:
25. H.K. Biesalski, R. Black (Eds.), Hidden Hunger. Malnutrition and the First 1,000 Days of Life: Causes, Consequences and Solutions, Karger, Basel, 2016.
26. MRC Vitamin Study Research Group, Prevention of neural tube defects: results of the Medical Research Council Vitamin Study, Lancet 338 (1991) 131-137.
27. N. Milman, Iron and pregnancy - a delicate balance, Ann. Hematol. 85 (2006) 559-565.
28. C. Breymann, Iron supplementation during pregnancy, Fet. Mat. Med. Rev. 13 (2002) 1-29.
29. Scholl TO, Iron status during pregnancy: setting the stage for mother and infant, Am. J. Clin. Nutr. 81 (2005) 1218S-1222S.
30. A.C. Ross, Vitamin A and carotenoids, in: M.E. Shils, M. Shike, A.C. Ross (Eds.), Modern Nutrition in Health and Disease, 10th Ed., Lippincott Williams & Wilkins, USA, 2006, pp. 351-375.
31. T. Grune, G. Lietz, A. Palou, et al., Beta-carotene is an important vitamin a source for humans, J. Nutr. 140 (2010) 2268S-2285S.
32. American Academy of Pediatrics Committee on Nutrition, Nutritional needs of preterm infants, in: R.E. Kleinman (Ed.), Pediatric Nutrition Handbook, 4th Ed, Elk Grove Village, IL, American Academy of Pediatrics, 1998, pp. 55-87.
33. C. Schulz, U. Engel, R. Kreienberg, H.K. Biesalski, Vitamin A and beta-carotene supply of women with gemini or short birth intervals: a pilot study, Eur. J. Nutr. 46 (2007) 12-20.
34. S. Meyer, L. Gortner, Early postnatal additional high-dose oral vitamin A supple- mentationversus placebo for 28 days for preventing broncho-pulmonary dysplasia or death in extremely low birth weight infants, Neonatology 105 (2014) 182-188.
35. E.A. Yetley, Assessing the vitamin D status of the US population, Am. J. Clin. Nutr. 88 (2008) 558S-564S.
36. B.L. Salle, E.E. Delvin, A. Lapillonne, et al., Perinatal metabolism of vitamin D, Am. J. Clin. Nutr. 71 (2000) 1317S-1324S.
37. F. Feron, T.H. Burne, J. Brown, et al., Developmental vitamin D3 deficiency alters the adult rat brain, Brain Res. Bull. 65 (2005) 141-148.
38. C.S. Zipitis, A.K. Akobeng, Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis, Arch. Dis. Child. 93 (2008) 512-517.
39. A. Lapillonne, Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes, Med. Hypotheses 74 (2010) 71-75.
40. M.B. Zimmermann, Iodine deficiency, Endocr. Rev. 30 (2009) 376-408.
41. D.V. Becker, L.E. Braverman, F. Delange, et al., Iodine supplementation for pregnancy and lactation - United States and Canada: recommendations of the American thyroid association, Thyroid 16 (2006) 949-951.
42. G. Morreale de Escobar, M.J. Obregon, F. Escobar del Rey, Role of thyroid hormone during early brain development, Eur. J. Endocrinol. 151 (Suppl. 3) (2004) U25-37.
43. P. Santiago-Fernandez, R. Torres-Barahona, J.A. Muela-Martinez, et al., Intelligence quotient and iodine intake: a cross-sectional study in children, J. Clin. Endocrinol. Metab. 89 (2004) 3851-3857.
44. R. Gartner, Thyroid disease in pregnancy, Curr. Opin. Obstet. Gynecol. 21 (2009) 501-507.
45. United Nations Subcommitee on Nutrition, Nutrition Policy Paper 18, (2000).
46. M.A. Hanson, P.D. Gluckman, Early developmental conditioning of later health and disease: physiology or pathophysiology, Physiol. Rev. 94 (2014) 1027-1076.
47. M.F. Laus, L.D. Vales, T.M. Costa, et al., Early postnatal protein-calorie malnutrition and cognition: A review of human and animal studies, Int. J. Environ. Res. Public Health 8 (2011) 590-612.
48. S. Grantham-McGregor, C. Ani, A review of studies on the effect of iron deficiency on cognitive development in children, J. Nutr. 131 (2001) 649-668.
49. WHO/UNICEF/ICCIDD, Assessment of iodine deficiency disorders and monitoring their elimination, in: 3rd Ed. (Ed.), Geneva World Health Organization, WHO Press, Geneva, Switzerland, 2007.
50. F. Azizi, A. Sarshar, M. Nafarabadi, et al., Impairment of neuromotor and cognitive development in iodine-deficient schoolchildren with normal physical growth, Acta Endocrinol. 129 (1993) 501-504.
51. F. Vermiglio, M. Sidoti, M.D. Finocchiaro, et al., Defective neuromotor and cognitive ability in iodine-deficient schoolchildren of an endemic goiter region in Sicily,
52. J. Clin. Endocrinol. Metab. 70 (1990) 379-384.
53. M.H. Abel, J.H. Caspersen, H.M. Meltzer, et al., Suboptimal maternal iodine intake is associated with impaired child neurodevelopment at 3 years of age in the Norwegian mother and child cohort study, J. Nutr. 147 (2017) 1314-1324.
54. S. Barth, C. Steer, J. Golding, et al., Effect of inadequate iodine status in UK pregnant women on cognitive outcomes in their children: results from the Avon Longitudinal Study of Parents and Children (ALSPAC), Lancet 382 (2013) 331-337.
55. C. Trumpff, J.D. Schepper, J. Tafforeau, et al., Mild iodine deficiency in pregnancy in Europe and its consequences for cognitive and psychomotor development of children: a review, J. Trace Elem. Biol. Med. 27 (2013) 174-183.
56. L.M. Bodnar, H.N. Simhan, R.W. Powers, et al., High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates, J. Nutr. 137 (2007) 447-452.
57. J. McCann, B.N. Ames, Is there convincing biological and behavioral evidence linking vitamin D to brain function, FASEB J. 22 (2008) 982-1001.
58. E.R. Leffelaar, T.G. Vrijkotte, M. van Eijsden, Maternal early pregnancy vitamin D status in relation to fetal and neonatal growth: results of the multi-ethnic Amsterdam Born Children and their Development cohort, Br. J. Nutr. 104 (2010) 108-117.
59. A. Whitehouse, B. Holt, M. Serralha, et al., Maternal serum vitamin D levels during pregnancy and offspring neurocognitive development, Pediatrics 129 (2012) 485-493.
60. R.D. Wilson, J.A. Johnson, P. Wyatt, et al., Pre-conceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with multivitamin supplements for the prevention of neural tube defects and other congenital anomalies, J. Obstet. Gynaecol. Can. 29 (2007) 1003-1026.
61. B.A. Haider, Z.A. Bhutta, Multiple-micronutrient supplementation for women during pregnancy, Cochrane Database Syst. Rev. 4 (2017) (CD004905).
62. A.E. Czeizel, M. Dobo, P. Vargha, Hungarian cohort-controlled trial of peri- conceptional multivitamin supplementation shows a reduction in certain congenital abnormalities, Birth Def. Res. A Clin. Mol. Teratol. 70 (2004) 853-861.
63. H.T. Wolf, H.K. Hegaard, L.D. Huusom, et al., Multivitamin use and adverse birth outcomes in high income countries: a systematic review and meta-analysis, Am. J. Obstet. Gynecol. 217 (2017) 404.
64. Y. Goh, E. Bollano, T.R. Einarson, et al., Prenatal multivitamin supplementation and rates of congenital anomalies: a meta-analysis, JOGC 28 (2006) 680-689.
65. M.L. Blumfield, A.J. Hure, L. Macdonald-Wicks, et al., A systematic review and meta-analysis of micronutrient intakes during pregnancy in developed countries, Nutr. Rev. 71 (2) (2013) 118-132.
66. P.N. Baker, S.J. Wheeler, T.A. Sanders, et al., A prospective study of micronutrient status in adolescent pregnancy, Am. J. Clin. Nutr. 89 (2009) 1114-1124.
67. S. ter Borg, S. Verlaan, J. Hemsworth, et al., Micronutrient intakes and potential inadequacies of community dwelling older adults: a systematic review, BJN 113 (2015) 1195-1206.
68. C. vonArnim, Nutrition security in older adults: status quo and future development, in: H.K. Biesalski, A. Drewnowski, J.T. Dwyer, et al. (Eds.), Sustainable Nutrition in a Changing World, Springer, Heidelberg, 2017.
69. B. Buijsse, E.J. Feskens, D. Schlettwein-Gsell, et al., Plasma carotene and alpha- tocopherol in relation to 10-y all-cause and cause-specific mortality in European elderly: the Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA), Am. J. Clin. Nutr. 82 (2005) 879-886.
70. C.W. Wong, Vitamin B12 deficiency in the elderly: is it worth screening? Hong Kong Med. J. 21 (2015) 155-164.
71. A.H. Leischker, G.F. Kolb, Vitamin B12 deficiency in the elderly, Z. Gerontol. Geriatr. 48 (2015) 73-88.
72. A. Waldmann, A. Strohle, J.W. Koschitzke, et al., Dietary intakes and lifestyle factors of a vegan population in Germany: results from the German vegan study, EJCN 57 (2003) 947-955.
73. N.B. Kristensen, M.L. Madsen, T.H. Hansen, et al., Intake of macro- and micronutrients in Danish vegans, Nutr. J. 14 (2015) 115-126.
74. G.B. Piccoli, R. Clari, F.N. Vigotti, et al., Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review, BJOG 122 (2015) 623-633.
75. E.J. van der Beek, Vitamin supplementation and physical exercise performance, J. Sports Sci. 9 (1991) 77-89.
76. J.A. Parnell, K.P. Wiens, K.A. Erdman, Dietary intakes and supplement use in preadolescent and adolescent Canadian athletes, Nutrients 26:8' (9) (2016).
77. J.M. MacKnight, Osteopenia and osteoporosis in female athletes, Clin. Sports Med. 36 (4) (2017) 687-702.
78. F. Farrokhyar, R. Tabasinejad, D. Dao, et al., Prevalence of vitamin D inadequacy in athletes: a systematic-review and meta-analysis, Sports Med. 45 (2015) 365-378.
79. K. Habte, A. Adish, D. Zerfu, et al., Iron, folate and vitamin B12 status of Ethiopian professional runners, Nutr. Metab. (Lond.) 12 (2015) 62.
80. Y. Kokubo, Y. Yokoyama, K. Kisara, et al., Relationship between dietary factors and bodily iron status among Japanese collegiate elite female rhythmic gymnasts, Int. J. Sport Nutr. Exerc. Metab. 26 (2016) 105-113.