Improving micronutrient status

• Hidden hunger, where diets have enough calories but not enough micronutrients, is a growing health issue – even in developed countries where nutritious food is easily accessible.
• The concept of nutrient density – eating foods rich in beneficial calories - has been presented as a solution to improving individuals’ micronutrient status and building healthy dietary habits amongst populations worldwide.
• Here, we explore the latest science around essential nutrients for tackling malnutrition, and the emerging approaches that will support researchers in the food and beverage industry in developing products that have a well-balanced nutritional profile.

Highlighting hidden hunger

Hidden hunger, where diets have an adequate caloric value but insufficient levels of micronutrients, is a growing health issue worldwide. It is a form of malnutrition that is prevalent in developed countries, even with nutritious food being widely available. Despite individuals being more informed than ever before about the impact of their dietary choices, many are still at risk of nutritional imbalances. This can have serious health consequences, often expressed in the form of non-communicable diseases (NCDs) such as osteoporosis, diabetes and cardiovascular disease.

Nutrient density: a measurement for healthier choices

The concept of ‘nutrition density’ has been identified as a dietary solution to hidden hunger. It puts a focus on the level of essential micronutrients in relation to total energy content of food and beverages. This data can then be shared with consumers on product labeling, equipping them with the information they need to be able to address any nutrient gaps in their own diet with supplements or fortified foods.

Malnutrition and obesity: a double burden

Sometimes even a well-balanced diet doesn’t always include enough micronutrients, and in populations where there is a growing incidence of obesity amongst children and adults, there’s an even greater risk of malnutrition and incidence of NCDs. In many cases, an inadequate micronutrient intake is only identified once testing has been carried out.

Assessing malnutrition in an obese world was the theme of the Federation of European Nutrition Societies (FENS) 2019 conference in Dublin where experts discussed the importance of regular examination of micronutrient supply in overweight individuals. There was a particular focus on children where the double burden of malnutrition and obesity has the potential to impair both physical and cognitive development.

Professor Manfred Eggersdorfer, Scientific Advisor to the DSM Nutrition Academy, discussed the concept of nutrient density at a DSM symposium at FENS 2019, highlighting its potential to improve the dietary habits and nutrient intakes of populations worldwide. Nutrition density provides a potential solution, as it encourages dietary choices that are both rich in nutrients and adequate in calories. However, to have an impact for the end consumer this approach needs to be adopted across governments, manufacturers, brands and retailers – highlighting the importance of nutrition education to implement changes such as:

• Increasing the nutritional information and education available to consume
• Increasing nutrients and reducing sugar, salt and unhealthy fat in food and beverage products (potentially with tax implementations
• Advocating balanced diets rich in fruits and vegetables
• Encouraging supporting healthy diets with supplements (particularly for nutrients such as vitamin D, where the recommended intake is difficult to reach through diet alone)

The future is fortified

Food fortification is widely used in nutritional intervention programs around the world to enhance the nutritional value of food and beverages. Nutrients such as calcium, iron, omega-3, dietary fiber and a range of vitamins can be added to food to give its nutritional profile a boost. For example, cereals are often fortified with iron, calcium and vitamin D and some B vitamins. Fortification can either be on a voluntary basis, where food and beverage manufacturers decide to add the nutrients to their products, or mandatory, where a country’s Government mandates it.

So, what are some of the key micronutrients that the industry should be focusing on to address hidden hunger?

• Conditionally essential omega-3 and 6 fatty acids; docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) and arachidonic acid (ARA) which offer nutritional benefits throughout an individual’s lifespan from healthy growth and development to improving cognitive performance later in life.
• Vitamin D; adequate intake of vitamin D has been shown – next to the benefit in bone and muscle health - to protect against cardiovascular disease and is essential for ensuring fetal development. However, evidence suggests that insufficient vitamin D levels are a global problem, and in particular, pregnant mothers are not achieving sufficient levels of vitamin D during pregnancy.
• Folic acid; essential for a healthy pregnancy and for reducing the risk of spina bifida and NTDs, folic acid helps to ensure cell growth as well as lowering blood levels of homocysteine (a risk factor for cardiovascular disease) – and may help tackle the growing incidence of hypertension amongst adults globally.
• Selenium; new studies have shown that levels of selenium directly correlate to bone mineral density.

Although nutrient density is not a term widely used outside of the nutrition industry, it represents the importance of a more holistic approach to health and wellbeing. By keeping up to speed with the latest consumer research, big data and new science, R&D teams can more easily identify the gap between what people say they are eating and where the nutritional deficiencies lie. There is a need for a pragmatic response to the malnutrition challenge in developed countries and a focus on nutrient density will ultimately support the development of healthy, nutrient-rich food and beverages that will help to address the micronutrient gap.