Children's Essential Nutrients: An Unmet Need and the Role of Dietary Supplements

The National Health and Nutritional Examination Survey (NHANES) is a federal program that began in the early 1960s and has been continuously running since 1999. The purpose of NHANES is to assess the health and nutritional status of adults and children in the United States. The results from the survey paint an interesting picture of the current nutritional status of our children. We see crucial micronutrient intakes far below the current recommended dietary allowances. Just a few examples from the average intakes in the data:¹

• Calcium – 73% of RDA


• Dietary Fiber – 42% of RDA


• Potassium – 70% of RDA


• Vitamin D – 42% of RDA

In 2020, JAMA published a paper that examined the data from the 2016 NHANES and the American Heart Association (AHA) dietary recommendations, which include fruits, vegetables, whole grains, and fish. This data is quite compelling, as only 0.25% of children were meeting the AHA recommendations, with 56.1% being in poor diet quality per the AHA.²

All of this data points to two clear facts. First, there is a need for a renewed focus on the quality of foods in our children’s diets. This includes introducing a variety of colors in the fruits and vegetables they eat, not relying on potatoes alone to fill the vegetable gap, and providing a variety of lean meats and fish to help meet the micronutrient needs of a growing child. Second, the judicious use of dietary supplements may be a great option for many families.

It is estimated that 34% of children and adolescents receive dietary supplements, with 23% of all surveyed receiving a multivitamin.³ It was stated in the abstract, "However, because nutritional needs should generally be met through food consumption according to the 2015-2020 Dietary Guidelines for Americans, only a few dietary supplements are specifically recommended for use among children and adolescents and only under particular conditions." This advice sounds good in theory, but the practice is just not finding its way into the homes of most families in the United States. When you look at the highly prevalent nutrient gaps, we need to recognize the value of supplements in helping to bring the child or adolescent back to adequacy.

The first place to start is ensuring adequate foundational nutrients (vitamins and minerals) to support a rapidly growing physical body and ever-changing emotional needs. A multivitamin is an easy and effective way to bridge vitamin and mineral gaps in the standard American diet. PureNutrients Gummy provides a comprehensive range of vitamins and minerals at doses that are appropriate for ages 3 and up in a great-tasting, fruit-flavored gummy. Junior Nutrients is a small capsule formulated for teens and children ages 4 and up. Both products offer vitamins A, B, C, D, E and K in highly bioavailable forms, easily absorbed mineral chelates and Metafolin® L-5-methyltetrahydrofolate (L-5-MTHF), the naturally occurring, universally metabolized form of folate.^‡

The NHANES data also suggests that omega-3 fatty acid intake in the U.S. population, including children, falls below the recommended levels. Omega-3 fatty acids, which include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are essential for brain development in children. EPA and DHA are mainly found in fatty fish. However, certain plant foods, like flaxseeds and walnuts, contain a precursor (alpha-linolenic acid) that is converted to active omega-3s in the body. The importance of omega-3 fatty acids in prenatal, postnatal, and adolescent brain in cognitive development is well-established.⁴An excellent place to start is with easily consumed EPA/DHA supplements like EPA/DHA Liquid and PureNutrients EPA/DHA Gummy.^‡

A good foundation goes beyond vitamins, minerals, and omega-3 fatty acids. Good digestive health and overall wellness in children are linked to healthy microbial diversity and microbial profile in the digestive tract.⁵ Many factors contribute to a healthy microbiome, such as dietary fiber and phytochemicals in fruits and vegetables. Consider a probiotic that is specifically formulated for children, such as Probiotic 123 powder. Digestive enzymes, such as Digestive Enzymes Chewable, also play a part in gastrointestinal health by aiding the digestion of protein, carbohydrates, fiber and dairy.^‡

Finally, recognize that some children may need higher amounts of 3 key nutrients than what is commonly found in multivitamins:

• Vitamin D₃ – It was estimated in 2004 that over 70% of children are insufficient in vitamin D3 (defined as less than 30 ng/dL at the time).⁶ This number is likely not any better today, as our children tend to be more indoor-oriented than ever, and sunlight is a major source of vitamin D. Appropriately, most providers are trying to obtain levels around 50 ng/DL to get maximum health benefits, which include immune function and emotional health.^‡


• Magnesium – Measuring magnesium status is very challenging. 99% of magnesium is outside the serum, so serum magnesium does not necessarily indicate actual magnesium status.⁷ Adequate magnesium intake is associated with brain health,⁸ healthy lung function,⁹ and metabolic health.^7‡


• Choline – Choline status requires a high index of suspicion, as there is no laboratory testing for this essential nutrient. It is necessary to get a diet history to identify adequate choline intake. Estimates show that choline inadequacy in the American population is between 80-90%, especially in children who practice a vegan diet, as most choline sources are animal-derived. Choline is essential for liver and nerve health. As a critical component in the neurotransmitter acetylcholine and the nerve sheath, sphingomyelin, it becomes vital for a healthy brain in the pediatric population.^‡

References

1. NCHS/DHNES. NHANES Select Mean Dietary Intake Estimates. CDC.gov. Published July 28, 2022. Accessed August 7, 2023. https://data.cdc.gov/NCHS/NHANES-Select-Mean-Dietary-Intake-Estimates/8wmh-yzz9


2. Liu J, Rehm J, Onopa J, Dariush Mozaffarian. Trends in Diet Quality Among Youth in the United States, 1999-2016. JAMA. 2020;323(12):1161-1161.


3. Stierman B, Mishra S, Gahche JJ, et al. Dietary Supplement Use in Children and Adolescents Aged ≤19 Years - United States, 2017-2018. MMWR Morb Mortal Wkly Rep. 2020;69(43):1557-1562. Published 2020 Oct 30.


4. Khalid W, Gill P, Arshad MS, et al. International Journal of Food Properties. 2022;25:1, 1021-1044.


5. Avelar Rodriguez D, Ryan PM, Toro Monjaraz EM, et al. Front Pediatr. 2019;7:363


6. Kumar J, Muntner P, Kaskel FJ, et al. Pediatrics. 2009;124(3):e362-e370.


7. Piuri G, Zocchi M, Della Porta M, et al. Nutrients. 2021;13(2):320. Published 2021 Jan 22.


8. Effatpanah M, Rezaei M, Effatpanah H, et al. Psychiatry Res. 2019;274:228-234.


9. Sedighi M, Pourpak Z, Bavarian B, et al. Iran J Allergy Asthma Immunol. 2006;5(4):183-186.