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Providing perspectives on recent research into vitamins and nutritionals


Hidden Hunger, Micronutrient Inadequacies and Health Consequences in the U.S.

By Michael McBurney

More than 1/3 U.S. adults are obese; 79 million people. Almost 1 out of 5 children and adolescents (17%) is overweight. In 2008, medical costs were $1,429 higher for obese versus normal weight individuals. Many presume that adiposity is the root cause of these additional health costs. Maybe not.

Vitamins and minerals are essential for normal growth, development and function. Fat accumulation occurs when energy intake exceeds expenditure (energy requirement for tissue maintenance and physical activity). The Dietary Guidelines of America 2010 recognized that many essential nutrients are being under consumed. Aggarwal and associates asked the question: Could the increased health risk of the overweight or obese be partly attributable to poorer micronutrient intakes than normal weight individuals?

Body mass index (BMI) and usual micronutrient intakes measured from dietary records were analyzed from 18,177 persons participating in the National Health and Nutrition Examination Survey (NHANES) 2001-2008. More than 40% of U.S. adults were not consuming recommended amounts of vitamins A, C, D, E, calcium and magnesium. Dietary intakes of vitamins A, C, D, E, dietary fiber, calcium, magnesium and potassium were significantly lower in the obese (BMI ≥ 30) than the normal weight (BMI < 25). About 20% more obese than normal weight adults were below the Estimated Average Requirement (EAR) for vitamins A, C and magnesium . The prevalence of inadequate intake of vitamins D and E was universally low regardless of BMI. The Healthy Eating Index (HEI) was significantly lower (2.6%) for obese adults but the gap was considerably less than the 5-12% differential observed in prevalence of micronutrient inadequacies.

Hidden hunger, obesity co-exisiting with micronutrient inadequacies, has insidious effects on development, maintenance and function of healthy cells within the body, including immune, cardiovascular, muscular, and brain cells.

An estimated 2 billion lives are affected by chronic deficiency of essential vitamins and minerals. As Aggarwal and colleagues indicate, many of these may live with America. Hidden hunger may partially explain why 10.7% of US government expenditures are spent on health.

Main Citation

Aggarwal S, Reider C, Brooks JR, Fulgoni VL. Comparison of prevalence of inadequate nutrient intake based on body weight status of adults in the United States: An analysis of NHANES 2001-2008. 2015 J Am Coll Nutr doi: 10.1080/07315724.2014.901196

Other Citations

Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: Payer- and service-specific estimates. 2008 HealthAffairs doi: 10.1377/hlthaff.28.5.w822

Kennedy G, Nantel G, Shetty P. The scourge of “hidden hunger”: global dimensions of micronutrient deficiencies. 2003 Food, Nutrition Agriculture. 32:8-16

Muthayya S, Rah JH, Sugimoto JD, Roos FF, Kraemer K, Black RE. The global hidden hunger indices and maps: An advocacy tool for action. 2013 PLoSONE doi: 10.1371/journal.pone.0067860