Vitamins and minerals: issues associated with too low and too high population intakes

Abstract

There is an ongoing increase in the availability of foods fortified with micronutrients and dietary supplements. This may result in differing intakes of micronutrients within the population and perhaps larger differences in intakes. Insight into population micronutrient intakes and evaluation of too low or too high intakes is required to see whether there are potential problems regarding inadequacy or excessive intakes. Too low population intakes are evaluated against an estimated average requirement; potential too high population intakes are evaluated against a tolerable upper intake level (UL). Additional health effects, seriousness, and incidence of these health effects are not considered but these can be taken into account in a benefit-risk assessment. Furthermore, authorities would like to regulate food fortification and supplementation in such a way that most of the population is not at risk of potentially high intakes. Several models are available for estimating maximum levels of micronutrients for food fortification and dietary supplements. Policy makers and risk managers need to decide how to divide the ‘free space’ between food fortification and/or dietary supplements, while protecting populations from adverse health effects.

Monitoring of essential and toxic elements in multi-ingredient food supplements produced in European Union

“…The investigated FS were multi-ingredient, contained various configurations of minerals and vitamins, and therefore differed in levels of essential elements. From the perspective of health protection, it is important to evaluate whether their concentrations do not exceed safety/guideline levels because an excessive intake can lead to various adverse effects including neurotoxic responses (Mn), cardiotoxicity (Co), gastrointestinal symptoms (Cu, Fe, K, Mg), altered immune function (Zn) or unwanted cardiovascular events (Ca) (Verkaik-Kloosterman et al 2012). Generally, our study demonstrated that the multi-ingredient FS produced in the EU have essential element concentrations decidedly below upper safety limits.…”

Addressing the risk of inadequate and excessive micronutrient intakes: traditional versus new approaches to setting adequate and safe micronutrient levels in foods

“…This uncertainty factor takes into account uncertainty including extrapolation from animals to humans, from sub-chronic to chronic exposure, and across age groups. Usual intakes at the UL therefore represent the highest level of intake that is likely to pose no risks of adverse effects in an age and gender group (18,19). As such, risks associated with intakes below the EAR and above the UL are different (18,19).…”

“…Usual intakes at the UL therefore represent the highest level of intake that is likely to pose no risks of adverse effects in an age and gender group (18,19). As such, risks associated with intakes below the EAR and above the UL are different (18,19). The EAR is the midpoint of required intakes at which the risk of inadequacy is 50%, whereas close to the UL the risk is negligible as the UL is set an uncertainty factor lower than the intake levels at and above which adverse effects may be expected (Fig.…”

“…What do the EAR and UL cut-points reflect in terms of risk Usual intakes at the EAR represent intakes that are inadequate for the prevention of inadequacy-related adverse effects in 50% of the population (18,19). The EAR values are established based on adverse effect indicators of inadequacy described in the scientific literature as, for example, serum or urinary biochemical markers, clinical markers, or intakes needed to maintain normal plasma ranges (18,19).…”

“…The EAR values are established based on adverse effect indicators of inadequacy described in the scientific literature as, for example, serum or urinary biochemical markers, clinical markers, or intakes needed to maintain normal plasma ranges (18,19). The Recommended Nutrient Intake (RNI) is set at two standard deviations above the EAR.…”