Gina has always fed her two kids a healthy diet — and they eat well, too. That’s why her pediatrician recommended she pass on the multivitamin. But after her youngest was chronically tired and sick, she had his nutrient levels checked. To her surprise, he was anemic and deficient in vitamin D.
The moral of the story? Even kids who eat healthy are vulnerable to nutrition deficits. That’s why we are addressing the nutrients children are most likely to be short on — and why. Sometimes supplements are needed but many times tweaks in the diet are all it takes.
So in our second post in our kids’ nutrition series, we’re looking at the research to determine “nutrients of concern” for kids of all ages. And we have 7 winners (or should I say losers):
The most common deficiency worldwide is iron. This remains a major challenge in developing countries but is still fairly common here in the U.S. According to the 2008 Pediatric Nutrition Surveillance Survey, nearly 15% of children 5 years and younger have iron deficiency anemia. Another vulnerable time for iron deficiency is during adolescence (for girls) when menstruation starts.
Why? During the first few years, there is rapid growth and the body can have trouble keeping up if there’s not enough iron. While iron has many functions in the body, one of its key responsibilities is to carry oxygen from the lungs to other parts of the body. During rapid growth, this is on overdrive. And when women and young girls have monthly periods, they lose additional iron.
There are two stages of iron deficiency. When iron stores are depleted it is called iron deficiency and there are usually no symptoms. But once iron deficiency anemia occurs, the levels in the blood dip and symptoms include tiredness, decreased immune function, impaired or slowed cognitive performance and glossitis (inflamed tongue).
The recommended amount of iron is 11mg for 7-12 months, 7mg for 1-3 years, 10mg for 4-8 years, 8mg for 9-13 years, 15mg for females 14-18 years, and 11mg for males 14-18 years. Food sources include meat, fish, poultry, beans, leafy greens, fortified cereals, and bread. See this list for more sources.
TIP! Heme sources of iron (meat, poultry, and fish) are better absorbed by the body than non-heme (plant sources). But by including non-heme with heme sources you increase the absorption of the latter. Vitamin C also increases the absorption of non-heme sources of iron by 3-4 times. Some great combos include vitamin C-rich fruit with fortified cereals and waffles, tomatoes with beans (think soups and burritos), and chili that contains meat, beans, and tomatoes.
2. Vitamin E
According to the Feeding Infants and Toddlers Study (FITS),63% of toddlers and 37% preschoolers fall short on vitamin E (infants actually meet or exceed their needs). Other population studies show that most age groups don’t meet the RDA for vitamin E which mainly functions as an antioxidant (protecting cells from the harmful effects of free radicals.) As a fat-soluble vitamin, vitamin E also needs fat to be absorbed.
Why? While no one knows for sure, there is speculation that the increased use of lower fat products, such as salad dressings, may be one of the reasons vitamin E intake is inadequate. That’s because vitamin E is found in vegetable oils and nuts and seeds. Vitamin E deficiency is rare and symptoms have not been reported in people with subpar intake.
The recommended amount of vitamin E is 5mg for 7-12 months, 6mg for 1-3 years, 7mg for 4-8 years, 11mg for 9-13 years and 15mg for 14 years and older. Food sources include nuts, seeds, vegetable oils and avocado — see list for more sources.
TIP! Crunchy nuts make great snacks for older kids and avocado is the perfect substitution for mayo on a sandwich. And wheat germ, a super source of vitamin E, is great in smoothies and baked goods.
3. Vitamin D
Even though it’s called a vitamin, scientists tend to think of vitamin D more like a hormone-based on its function. While vitamin D is needed for the body to deposit calcium in bones, it also plays a role in many bodily functions as every cell in the body has a vitamin D receptor. Inadequate intakes have been linked to the development of certain cancers, immune-disorders, cardiovascular disease, and diabetes.
While most conservative estimates show that 25% of the population have low blood levels of vitamin D, a study in Pediatrics found 7 out of 10 lids had blood levels that were inadequate. The reason for the discrepancy is researchers have not come to a consensus on what blood levels are optimal.
Why? For most of human history, people did not rely on food to get their vitamin D, they got it from the sun. With sunscreen, indoor jobs and obesity, most people don’t get the vitamin D their bodies need. Consider that a half hour in the sun at peak times provides 10,000IU vitamin D and a glass of milk only contains 100.
Rickets is the result of severe vitamin D deficiency and is rare but still reported. Low vitamin D status often goes unnoticed. Symptoms may include bone pain and muscle weakness.
The recommended amount of vitamin D is 600 IU for 1 year and older. Food sources include fatty fish, fish liver oils and fortified products such as milk and orange juice. The American Academy of Pediatrics (AAP) recommends that breastfed infants receive supplements of 400 IU/day of vitamin D and older kids who don’t get enough through food supplement as well.
I got the chance to pick Karen Kafer’s brain, a registered dietitian at the National Dairy Council. She explained how strong bones built during childhood and adolescence can help lower the risk of osteoporosis in later years. This bone-building occurs until we are about 30 years old, then the body stops adding new bone. So what we are doing during this time — eating well, getting enough calcium and exercise — can make the difference between a frail and a strong skeleton.
“Many children and adults (with the exception of children 1-3 years) aren’t getting the amount of calcium recommended for their age group – and some have particularly low intakes,” she says. “For example, only 15 percent of females aged 9-13 years and 13 percent of females ages 14-18 meet their calcium needs — and that’s from all sources (diet and supplements).
Why? According to a study published in the Journal of Pediatrics, by the time a girl reaches 19 she’s drinking three times more soda and 25% less milk than she did as a child. Right when calcium needs shoot up, and peak bone-building occurs, calcium intake declines with soda and other sweetened beverages replacing calcium-rich milk.
The recommended amount of calcium is 700mg for 1-3 years, 1000mg for 4-8 years, 1300mg for 13-18-year-olds. See list for dairy sources and nondairy sources. Symptoms of calcium deficiency most likely won’t show up until later in life.
According to the Dietary Guidelines for Americans, potassium is a shortfall nutrient in the American diet. The FITS study also indicates that young children come up short.
Potassium is an electrolyte involved in cellular and electrical body functions — and is essential to body tissues, cells, and vital organs. As electrolytes, sodium, and potassium work together as a team. Too much sodium (we will talk about this in the next post) can increase blood pressure while potassium has the opposite effect. Adequate potassium in the diet also decreases the risk of kidney stones and enhances bone health.
Why? Health professionals speculate that low potassium levels are due to less-than-adequate intakes of fruits, vegetables, and dairy products and too many processed foods and sweetened beverages.
Recommended amounts of potassium include 3g for 1-3 years, 3.8g for 4-8 years, 4.5g for 9-13 years and 4.7g for 14-18 years. Because potassium is contained in so many foods, an overt deficiency caused by diet is rare. Yet moderate reductions in potassium can increase the risk of high blood pressure.
See this list for food sources.
6. Essential fatty acids
While we will save all the juicy details on fat for another post in this series, it’s important to note that many kids are not getting the right types of fat — and in some cases may not be getting enough total fat. According to the FITS study, total fat intake in children 5 and younger is actually below Acceptable Macronutrient Distribution Ranges. But it’s the imbalance of the types of fat that children are consuming that is problematic.
Fiber is the undigestible part of carbohydrates that play an important role in health. Most Americans don’t get enough — and that includes children. Beans and peas are the star players when it comes to fiber, followed by fruits, vegetables, whole grains, and nuts. Fiber helps with feeling full, prevents constipation and has other benefits we will discuss later (think pre and probiotics).
Why? When people consume too many processed foods — white bread, juice, meats and not enough fresh foods fiber intake lags behind.
The adequate intake for fiber is 14 g per 1,000 calories or 25 g per day for women and 38 g per day for men. Most Americans get only 15 g per day. See this list for fiber sources.
Putting it all together
We’ll be talking about how to make diet changes — and decide if supplementation is needed later in the series. The goal is to give you an idea of which nutrients are most likely to be missing in your kids’ diet.
“I’m a big believer of getting our vitamins and minerals through diet, but know, first hand, that our bodies don’t always absorb naturally occurring nutrients to the degree we need,” Gina says about her experience with her child.
Next time we’ll be discussing nutrients kids can get too much of. Any questions or concerns?
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Polhamus B, Dalenius k, Nackentosh H, Smith b, Grummer-Strawn l. Pediatric Nutrition Surveillance 2008 Report, Atlanta GA: Us Department of Health and Services, Centers for Disease Control and Prevention: 2009.
Butte NF, Fox MK, Briefel RR, Siega-Riz AM, Dwyer JT, Deming DM, Reidy KC. Nutrient intakes of US Infants, toddlers, and preschoolers meet or exceed dietary reference intakes. J Am Diet Assoc. 2010;110:S27-S37.
Kumar J, Muntner P, Kaskel FJ, Hailpern SM, Melamed ML. Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: Nhanes 2001-2004. Pediatrics (doi:10. 1542/peds.2009-0051.)
Striegel-Moore RH, Thompson D, Affenito SG, Franko DL, Obarzanek E, Barton BA, Schreiber GB, Daniels SR, Schmidt M, Crawford PB. Correlates of beverage intake in adolescent girls: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2006 Feb;148(2):183-7.