Nutrient Status is More Important than Nutrient Intake
For the most part, our bodies can interconvert macronutrients but vitamins and minerals must be consumed. Our bodies use carbohydrates, proteins, fats, and alcohol as energy sources. While some amino acids and fatty acids are essential (must be ingested), excess protein, carbohydrates, and fats are metabolized and stored in adipose tissue (as fat). Because of inadequate intakes of vitamins and minerals, people (and animals) can be overweight, even obese, and still malnourished.
While low dietary intakes of vitamin D, vitamin E, folate, and vitamin C are correlated with mortality, estimates of nutrient intake are crude estimates of nutrient status. Basically, we aren’t very good at recording what and how much we eat. However, our bodies are made from what we eat. Our cells (blood, tissue, urine) are the most accurate reflection of our nutritional status.
In a meta-analysis of 12 studies, Schottker and colleagues reported a 20 nmol/L increase in serum 25(OH)D3 concentrations was associated with an 8% decrease in all-cause mortality.
Wright and colleagues reported higher α-tocopherol (vitamin E) concentrations were associated with significantly lower total mortality in men. Relative risk (RR) of dying (Figure 2) decreased ~35% as serum serum α-tocopherol concentrations increased from 16.3 µmol/L (RR = 1.3) to 30 µmol/L (RR = 0.85).
Increasing folate status reduces homocysteine concentrations (hypothesized to reduce cardiovascular disease and mortality). Polymorphisms in the gene encoding for the 5,10-methylenetetrahydrofolate reductase enzyme (MTHFR) affects folate and homocysteine concentrations. The interactions of genetic permutations and dietary folate intake affect folate status and mortality (Yang et al, 2012).
Low serum ascorbate (vitamin C) concentrations are associated with a 57% higher risk of mortality and 62% higher risk of cancer (vs those with highest quintile). Men in the lowest quintile had vitamin C concentrations below 28.4 µmol/L. According to the CDC, 7.3% of US male residents are vitamin C deficient (<11.4 µmol/L).
Hidden hunger exists. Despite the fact that 34.9% of US adults are obese and about 2/3 are overweight, studies find health risks associated with inadequate vitamin and mineral intakes. Being healthy involves more than maintaining a healthy body weight. Micronutrients are essential for life.
Choose foods intrinsically rich in vitamins and minerals. Enriched and fortified foods are important sources of micronutrients. And dietary supplements, especially multivitamin and mineral products, can help fill micronutrient gaps.
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Enstrom JE, Kanim LE, Klein MA. Vitamin C intake and mortality among a sample of the United States population. 1992 Epidemiol 3:194-202
Losonczy KG, Harris TB, Havlik RJ. Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: the Established Populations for Epidemiologic Studies of the Elderly. 1996 Am J Clin Nutr 64:190-196
Voutilainen S, Rissanen TH, Virtanen J, Lakka TA, Salonen JT. Low dietary folate intake is associated with an excess incidence of acute coronary events: The Kuopio Ischemic Heart Disease Risk Factor Study. 2001 Circulation doi: 10.1161/01.CIR.103.33.2674
Wright ME, Lawson KA, Weinstein SJ, Pietinen P, Taylor PR, Virtamo J, Albanes D. Higher baseline serum concentrations of vitamin E are associated with lower total and cause-specific mortality in Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. 2006 Am J Clin Nutr 84:1200-1207
Schottker B, Ball D, Gellert C, Brenner H. Serum 25-hydroxyvitamin D levels and all mortality. A systematic review and meta-analysis of prospective cohort studies. 2013 Ageing Res Rev doi: 10.1016/j.arr.2012.02.004
Yang Q, Bailey L, Clarke R, Flanders Wd, Liu T, Yesupriya A, Khoury MJ, Friedman JM. Prospective study of methylenetetrahydrofolate reductase (MTHFR) variant C677T and risk of all-cause and cardiovascular disease mortality among 6000 US adults. 2012 Am J Clin Nutr doi: 10.3945/ajcn.111.022384
Loria CM, Klag MJ, Caulfield LE, Whelton PK. Vitamin C status and mortality in US adults. 2000 Am J Clin Nutr 72:139-145