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Making Micronutrient Adequacy of American Children a Reality

Altschwager, Deena K. MS, RD, LDN; Dwyer, Johanna T. DSc, RD

doi: 10.1097/NT.0000000000000191
Nutrition and the Lifecycle

The 2015 to 2020 Dietary Guidelines for Americans reports that calcium, vitamin D, potassium, and dietary fiber are still nutrients of public health concern. This article describes ways to make children’s micronutrient adequacy a reality with a combination of nutrition education, enrichment, fortification, and, in some instances, dietary supplementation. All of these strategies have a place, but they are not panaceas. For many years, enrichment of wheat flour and cereals with thiamin, niacin, riboflavin, and iron; fortification of margarine with vitamins A and D; milk with vitamin D; juices with vitamin C; iodine in salt; iron-fortified infant formulas; and highly fortified cereals with many vitamins and minerals have improved the diets of children. More recently, fortification of wheat flours and cereals with folic acid has also helped achieve folic acid adequacy in most of the population. Fortification has been less successful in bringing intakes of vitamin D up to recommended levels due to decreased consumption of dairy products. Iron fortification is difficult because iron fortificants are poorly bioavailable or cause rancidity. Potassium, calcium, and magnesium are gritty, making them difficult to fortify or add to supplements. In addition, fiber cannot be easily added to food because of its bulk. Dietary supplements are another source of nutrients, but they often contain too much of some nutrients, not enough of others, and compliance among children is variable. Adequate diets for children depend on nutrition education that encourages food intakes that are dense in micronutrients, high in dietary fiber, lower in calories, and lower in nutrients of excess such as saturated fat, sugar, and salt. A judicious combination of nutrition education, enrichment, and fortification, coupled with continuous monitoring to ensure total intakes are adequate but not excessive, can make micronutrient adequacy a reality for all American children.

Deena K. Altschwager, MS, RD, LDN, is a nutrition fellow in the Division of Adolescent/Young Adult Medicine at Boston Children’s Hospital, Massachusetts.

Johanna T. Dwyer, DSc, RD, is a professor at Tufts University School of Medicine and Friedman School of Nutrition Science and Policy and a senior nutrition scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts.

Ms Altschwager has no conflicts of interest to disclose. Dr Dwyer has stock in several food and drug companies. She is a nonpaid advisor to ILSI North America fortification and bioactives committee and received an honorarium in May 2015 for a talk at General Mills on fortification. She is also a consultant to Nestle on child nutrition surveys. She has no grants or contracts or any other relevant conflicts.

Correspondence: Deena K. Altschwager, MS, RD, LDN, 300 Longwood Ave, Mailstop 306, Boston, MA 02115 (

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