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* Vitamin Status in the US Warfighters


* A Look into Americans Attitudes to Food in 2021


* Do High Levels of Prenatal Folic Acid Cause Food Allergies?



Military populations may be more susceptible to vitamin deficiencies and disorders because of their frequent deployment to harsh environments, high levels of physical activity, and limited availability of fresh food. A landmark study just published examines incidence rates, temporal trends, and demographic factors associated with vitamin deficiencies/disorders in approximately 1.3 million US military personnel per year from 1997 to 2015. Investigators used the Defense Medical Epidemiological Database records and searched for specific International Classification of Diseases codes to determine incidence of clinically diagnosed vitamin deficiencies/disorders and their associations with demographic factors. Because clinical signs of vitamin deficiencies are rather nonspecific, the findings should be taken as indicators of potential risk and not actual deficiency until confirmed with additional data. The findings are useful because they single out those possibly at risk and help guide decision making on further testing for nutritional deficiencies and also for designing and delivering public health messages and information to those at a high risk.


The overall incidence rate of vitamin deficiencies/disorders was 92.7 cases per 100 000 person-years (p-yr), which is quite low and good news indeed. Highest rates were for the following:


* Vitamin D (53.7 cases/100 000 p-yr)


* B-complex vitamins (20.2 cases/100 000 p-yr)


* Vitamin B12 deficiency anemia (7.6 cases/100 000 p-yr)


* Deficiencies of "other vitamins" (5.9 cases/100 000 p-yr)


* Vitamin A (2.5 cases/100 000 p-yr)


* Thiamin, riboflavin, niacin, pyridoxine, folate, vitamin C, and vitamin K deficiencies and hypervitaminoses A and D had less than 1 case per 100 000 p-yr.



Rates for vitamin D, other B-complex, "other vitamin," and thiamin deficiencies increased over time, whereas vitamin A and C deficiencies decreased. The overall rate of clinically diagnosed vitamin deficiencies and disorders was low but higher in women and minority subgroups. Women had a higher incidence rates of most deficiencies/disorders except niacin and vitamin C. Incidence rates rose with age in 8 of 15 deficiency/disorder categories, and Blacks had higher incidence rates than other ethnic groups in 9 of 15 deficiency/disorder categories.


Source: Knapik JJ, Farina EK, Fulgoni VL, et al. Clinically-diagnosed vitamin deficiencies and disorders in the entire United States military population, 1997-2015. Nutr J 2021;20:55.



According to the International Food Information Council's (IFIC), a year ago, most Americans reported having experienced some change to their eating or food preparation habits because of the COVID-19 pandemic. In the just released IFIC 2021 Food & Health Survey, however, that number had fallen to 72%. The survey also found significant decreases-sometimes by as much as half-in behaviors that had changed because of the pandemic. One year ago, 60% of consumers said they were cooking at home more than usual; this year, that number fell to 47%. Similarly, the number of Americans during that same period who reported engaging in other behaviors more often than usual dropped precipitously: snacking more (32% in 2020 vs 18% in 2021), washing fresh produce more (30% in 2020 vs 22% in 2021), thinking about food more (27% in 2020 vs 13% in 2021), eating more in general (20% in 2020 vs 11% in 2021), and eating more premade meals from the pantry or freezer (19% in 2020 vs 11% in 2021).


At the same time, the survey suggests that some changes Americans made last year have continued or even accelerated in 2021. For example, 27% of Americans in 2019 said they shopped for food online at least once a month; in 2020, it went up to 33% in the early days of COVID; and this year (2021), it climbed even higher to 42%. Similarly, 13% of adults in 2019 said they shopped for food online at least weekly, 11% did so in 2020, and in 2021, the number jumped to 20%. Younger consumers, African Americans, and parents tended to grocery shop online more frequently than their counterparts. Survey results were derived from online interviews of 1014 Americans aged 18 to 80 years, conducted in March 2021, by Greenwald Research, using Dynata's consumer panel. The results were weighted by age, education, gender, race/ethnicity, and region to ensure that they are reflective of the American population ages 18 to 80 years, as seen in the 2020 Current Population Survey.


Here are some other highlights that provide food for thought for nutrition educators and counselors that suggest a lot of consumers need help in separating marketing hype from scientific realities when it comes to food safety and health:


Nearly two-thirds (63%) of adults say the ingredients in a food or beverage have at least a moderate influence on what they buy. When shopping, most Americans cite that the product itself is where they look for information about the ingredients, with 6 in 10 (62%) consulting the ingredients list and half (52%) looking at front-of-package information. Other sources of information trail far behind, including the websites or social media accounts of brands/companies (20%), family or friends (16%), and QR codes on packages (8%). However, younger adults (younger than 45 years), those with college degrees, and people in the highest income bracket (>$80k/year) are more likely to consult brand/company websites or social media compared with their counterparts.


Americans are paying more attention to ingredient lists, choosing clean ingredients, and avoiding chemical sounding ingredients. The survey also found diverging opinions about preservatives: More than 4 in 10 (42%) agree that adding preservatives to foods is a way to help reduce food waste (21% disagree), and 39% agree that adding an ingredient to a food would be positive if it extended shelf life (23% disagree). Men were more likely than women to strongly agree with these statements.


The words "natural" and "artificial" evoke strong reactions around food choices. Approximately half of Americans say they seek out natural flavors at least some of the time, 41% seek out natural sweeteners, 40% seek out natural preservatives, and 35% seek out colors from natural sources. In contrast, artificial flavors, colors, sweeteners, and preservatives were sought out by only about 1 in 10 consumers, with approximately half saying they avoid each of them at least some of the time.


Nearly 2 in 3 survey takers (64%) say they try to choose foods made with "clean" ingredients. When these respondents were asked how they define clean ingredients, "not artificial or synthetic" was the top choice of 22%, whereas 16% chose "organic," 15% chose "fresh," 14% cited "something they know is nutritious," and another 14% selected "natural." At the bottom of the list, 6% cited the following options as their top choice: something with a familiar or recognizable name, something that does not have a chemical-sounding name, and something with a name they can pronounce.


Nearly half consider themselves to be" clean" eaters. One in 5 (21%) rank "eating foods that aren't highly processed" as their top definition of the term (nearly half, 49%, rank this in their top 3). Another 14% of self-described clean eaters define it as eating foods found in the fresh produce section, 13% as eating organic foods, 11% as eating foods with simple ingredient lists, and 9% as eating foods with ingredients they only consider to be "clean."


Of those who choose foods and beverages with" clean" ingredients, a quarter reported that health benefits were their top motivation. An additional 1 in 5 (21%) cite that they are looking to avoid the possible harmful effects of chemical-sounding ingredients, 18% most want to avoid the possible harmful effects of unfamiliar ingredients, 18% want to be familiar with what goes into the foods and beverages they choose, and 17% who think foods and beverages with clean ingredients are more nutritious.


Health-related factors also impacted the list of reasons consumers avoid ingredients with "chemical-sounding" names. More than a quarter (26%) selected general health concerns for themselves as the top reason, 20% chose general health concerns for their family, 13% cited cancer, 8% cited that the ingredients were unfamiliar to them, 7% chose digestive issues, and 7% cited environmental concerns. Concerns around ingredient sensitivities (6%), food allergies (5%), and foodborne illness (5%) ranked just slightly lower.



Source: Report from the IFIC, "From 'Chemical-sounding' to 'Clean': Consumer Perspectives on Food Ingredients." Accessed June 20, 2021.