Database Development to Assess the Nutritional
Impact of Food Fortification, Enrichment, and
Dietary Supplements Using USDA Nutrient
Composition and Consumption Survey Data
Debra R. Keast, PhD
Food & Nutrition Database Research Inc., Okemos, MI
35 th National Nutrient Databank Conference
April 8, 2011 – Bethesda, MD

Aims of this project were to determine:
1.
Percentages of added (from fortification or
2.
enrichment) nutrient intake contributed from food sources;
Contributions of food fortification, enrichment and dietary supplements to total
3.
nutrient intake; and
The impact of food fortification, enrichment and dietary supplements on usual intake in relation to Dietary Reference Intakes.
2






A database was developed to separate naturally occurring and added nutrients in enriched or fortified foods
Intake from each separate category was determined using NHANES 2003-2006 data
Nutrient intake from dietary supplements was also assessed
Sources of nutrient intake were determined
Usual intake was estimated using the
National Cancer Institute (NCI) methodology
3


Leveraged existing USDA databases




USDA Nutrient Database for Standard Reference
Release 18 (SR-18), and the SR-Link file of the
Food and Nutrient Database for Survey Foods, version 2 (FNDDS 2.0) for NHANES 2003-2004
SR-20 and FNDDS 3.0 for NHANES 2005-2006
Vitamin D Addendum to FNDDS 3.0
MyPyramid Equivalents Database, version 2
4

Added Nutrients Contained in Food





USDA databases include folic acid (separate from food folate), added vitamin E, and added vitamin B12 food composition values
Folic acid content used to determine thiamin, riboflavin, niacin, and iron added to enriched flour, pasta and rice in grain mixtures
Milk & margarine fortified w/ vitamins A & D
Vit. D-, Ca-suppl. juice, fruit drinks w/ vit. C
Fortification of RTE cereals quantified by difference between total and naturallyoccurring nutrients in grains, fruit, nuts
5

Added nutrients determined by difference between enriched and unenriched grain product: Wheat flour, all-purpose
Wheat flour, all-purpose
Enriched
Unenriched
Added
Folate mcg/100g
183
29
154
Thiamin mg/100g
0.785
0.120
0.665
Riboflavin mg/100g
Niacin mg/100g
0.494
0.040
0.454
5.904
1.250
5.654
Iron mg/100g
4.64
1.17
3.47
6

Added nutrients from enriched flour content:
Bread, white, commercially prepared
Bread, white, commercial
Total per 100g
Added per 100g
Added (%)
Folate mcg
111
86
77.5
Thiamin mg
0.455
0.371
81.6
Riboflavin mg
0.331
0.254
76.6
Niacin mg
4.385
2.599
59.3
Iron mg
3.74
1.94
51.8
7

Added nutrients determined by difference between enriched and unenriched grain product: Rice, white, long-grain, cooked
Rice, white, cooked
Enriched
Unenriched
Added
Folate mcg/100g
58
3
55
Thiamin mg/100g
0.163
0.020
0.143
Riboflavin mg/100g
Niacin mg/100g
0.013
0.013
0.000
1.476
0.400
1.076
Iron mg/100g
1.20
0.20
1.00
8

Added nutrients determined by difference between enriched and unenriched grain product: Noodles, egg, cooked
Enriched
Unenriched
Added
Folate mcg/100g
84
7
77
Thiamin mg/100g
0.289
0.030
0.259
Riboflavin mg/100g
Niacin mg/100g
0.136
0.020
0.116
2.077
0.400
1.677
Iron mg/100g
1.47
0.60
0.87
9

Added nutrients from enriched macaroni, flour, and bread crumbs in recipe:
Macaroni or noodles with cheese
Macaroni with cheese
Folate mcg
Total per 100g 31.2
Added per 100g 25.3
Added (%) 81.2
Thiamin mg
0.163
0.114
69.8
Riboflavin mg
0.236
0.054
23.2
Niacin mg
1.100
0.695
63.3
Iron mg
0.97
0.52
51.8
10

Recipe in SR-Link file of FNDDS:
Macaroni or noodles with cheese
Fd Code Food Description
20100 Macaroni, cooked, enriched
4610 Margarine
20081 Wheat flour, white, enriched
2047 Table salt
11100000 Milk, NFS
14410200 Cheese, processed, american/cheddar
18079 Bread crumbs
Moisture loss
Gm Wt
40.8
3.9
1.6
0.2
33.9
15.8
3.8
-10.0
11

Added vitamin A determined by difference between milk with and without vitamin A
Milk Type
Whole, 3.25% fat
Reduced (2%) fat
Low (1%) fat
Nonfat or skim
Milk, NFS
Gram
Weight
(%)
With
Vit. A
( µ g ARE)
36.9
34.1
12.4
16.6
28.0
55.0
58.0
61.0
46.4
Without
Vit. A
( µ g ARE)
Added
Vit. A
( µ g ARE)
28.0
28.0
14.0
2.0
21.9
0.0
27.0
44.0
59.0
24.5
Added
Vit. A
(%)
0.0
49.1
75.9
96.7
52.7
12

Added vitamin D determined by difference between milk with and without vitamin D
Milk Type
Whole, 3.25% fat
Reduced (2%) fat
Low (1%) fat
Nonfat or skim
Milk, NFS
Gram
Weight
(%)
36.9
34.1
12.4
16.6
With
Vit. D
(IU)
51.0
49.0
48.0
47.0
49.3
Without
Vit. D
(IU)
2.0
1.0
1.0
0.0
1.2
Added
Vit. D
(IU)
Added
Vit. D
(%)
96.1
49.0
48.0
47.0
98.0
97.9
47.0
100.0
48.1
97.6
13

Added vitamins A and D from fortification of milk and margarine in recipe:
Macaroni or noodles with cheese
(89.6 µ g ARE vitamin A, and 24.6 IU vitamin D in total from recipe)
Macaroni with cheese
Vitamin A
( µ g ARE)
Vitamin A (%)
Vitamin D (IU)
Vitamin D (%)
Added from
Milk
Added from
Margarine
9.2
35.7
10.3
18.1
73.5
39.8
2.8
11.3
Total
Added
44.9
50.0
20.9
84.9
14

Fortification of RTE cereals quantified by difference between total and naturallyoccurring nutrients in grains, nuts, fruit
Healthy Choice Almond Crunch with Raisins (Food Code 57232100)
Nutrient Total
Flour
(2.1 oz-eq)
Almonds
(0.40 oz-eq)
Raisins
(0.19 cup-eq)
Not
Added Added
Added
(%)
Vit. D ( µ g) 3.45
0.00
0.00
0.00
0.00
0.00
100.0
Vit. A ( µ g) 258 0.00
Vit. C (mg) 0.00
-
Vit. B6 (mg) 1.20
0.02
Folate ( µ g)
Thiamin (mg)
Riboflvn (mg)
200 -
0.90
0.04
1.00
0.01
0.00
-
0.01
-
0.01
0.05
0.00
-
0.02
-
0.01
0.02
0.00
0.00
100.0
0.00
0.0
0.05
1.15
96.1
20 180 90.0
0.07
0.83
92.3
0.08
0.92
92.3
15

Fortification of RTE cereals quantified by difference between total and naturallyoccurring nutrients in grains, nuts, fruit
Healthy Choice Almond Crunch with Raisins (Food Code 57232100)
Nutrient Total
Flour
(2.1 oz-eq)
Almonds
(0.40 oz-eq)
Raisins
(0.19 cup-eq)
Not
Added Added
Added
(%)
Niacin (mg) 12.1
0.43
Iron (mg) 10.9
0.40
Ca (mg)
P (mg)
49.0
236
5.1
36.9
Mg (mg)
Zn (mg)
Cu (mg)
89.0
2.60
0.30
7.5
0.24
0.05
0.22
0.24
14.0
26.7
15.5
0.19
0.06
0.11
0.26
7.0
14.1
4.5
0.03
0.05
0.76
11.34
31.2
0.9
10.0
30.5
26.1
22.9
1.3
77.7
158.3
8.7
27.5
61.5
0.46
2.14
0.16
0.14
8.5
7.8
4.0
16



Data from the 2003-2004 and 2005-2006
National Health and Nutrition Examination
Surveys (NHANES) were combined
Analyses included 16,110 participants aged
2+ yr who had complete 24-hour dietary intake data


Pregnant and/or lactating females were excluded from analyses
Age-gender groups used by the Institute of
Medicine to establish Dietary Reference Intakes
(DRI) were evaluated
17



Food groups similar to those used by USDA in the Dietary Sources of Nutrients database


However, mixtures were not disaggregated
Food grouping collapsed to ~50 food groups
Mean intakes of fortified, enriched, and naturally-occurring nutrients; and the percentages contributed from food groups

Data were summarized to show major food sources of nutrient categories
18

100%
Other foods
80%
60%
40%
20%
0%
Other beverages
Fruit drinks
Fruit juice
Meal supplements
Milk and milk products
Other grain products
Cereal bars, PopTarts
Ready-to-eat cereal
Vit. D Vit. A Vit. C Vit. B6 Vit. B12
Source: NHANES 2003-2006 one-day intake analyses
19

100%
Other foods
80%
60%
40%
20%
0%
Other mixtures
Pasta & pasta dishes
Rice & rice mixtures
Hot breakfast cereal
Snack foods
Grain desserts
Pizza & turnovers
Biscuit/pancake/tortilla
Bread, sandwiches
Thiamin Riboflvn Niacin Folate Iron
Source: NHANES 2003-2006 one-day intake analyses
20

100%
Other foods
80%
Other beverages
60%
Fruit drinks
Fruit juice
Meal supplements
40%
20%
Milk and milk products
Other grain products
Cereal bars, PopTarts
Ready-to-eat cereal
0%
Thiamin Riboflvn Niacin Folate Iron
Source: NHANES 2003-2006 one-day intake analyses
21

100%
Other foods
80%
Other beverages
Fruit drinks
60%
40%
20%
0%
Fruit juice
Meal supplements
Milk and milk products
Other grain products
Cereal bars, PopTarts
Ready-to-eat cereal
Ca P Mg Zn Cu
Source: NHANES 2003-2006 one-day intake analyses
22




Dietary supplements questionnaire

Usage of vitamins, minerals, botanicals, and other dietary supplements over the past 30 d


Number of days the dietary supplement was taken
Amount usually taken per day on days it was taken
Dietary supplements database

Product information recorded by the interviewer


Labeled dosage or serving size
Amounts of ingredients per serving
Average daily intake of nutrients from dietary supplements was calculated
23



Mean nutrient intake from naturally occurring sources, enrichment, fortification, and dietary supplements was determined

To facilitate this presentation, nutrient intake was expressed as a percentage of the DRI, to place mean intake of all nutrients on the same scale
The percentage of total intake contributed from each source was determined
24

600
500
400
300
200
100
0
Vit. D Vit. A Vit. C Vit. E Vit. B6
Source: NHANES 2003-2006 one-day intake analyses
Dietary Supplements
Added (fortified)
Naturally-occurring
25

600
500
400
300
200
100
0
Thiamin Riboflvn Niacin Folate Iron
Source: NHANES 2003-2006 one-day intake analyses
Dietary Supplements
Added (fortified)
Added (enriched)
Naturally-occurring
26

600
500
400
300
200
100
0
Ca P Mg Zn Cu Se
Source: NHANES 2003-2006 one-day intake analyses
Dietary Supplements
Added (fortified)
Naturally-occurring
27



In general,

Major sources of vitamins were enrichment/ fortification and/or dietary supplements




Major sources of minerals (except for iron) were naturally occurring in foods
In particular,

Fortification was a major source of vitamins D & A
Most vitamin E was from dietary supplements
Both enrichment and fortification were major sources of thiamin, folate, and iron
Mean intake of naturally occurring vitamins D, A, and E; thiamin, folate, Ca and Mg were low
28



Existing food and nutrient databases developed by USDA for NHANES are invaluable resources
Databases were used to separate naturally occurring and added nutrients in enriched or fortified foods

The focus of a manuscript submitted to Journal of Nutrition is usual intake in relation to Dietary
Reference Intakes for all 2+, 2-18 and 19+ y
29

Collaborator:
Victor Fulgoni III, PhD of Nutrition Impact LLC located in Battle Creek, MI
Other coauthors:
Johanna Dwyer, DSc, RD and Regan Bailey, PhD, RD
National Institutes of Health (NIH),
Office of Dietary Supplements
Funding Source:
International Life Sciences Institute (ILSI)
North America, Fortification Committee
30