Hidden Health Worries For Young People Due To Nutritional Shortfalls

A new report from the Health and Food Supplements Information Service (HSIS) reveals soaring numbers of teens and young adults with seriously inadequate intake of vitamins and minerals are going unrecognised, with the situation set to worsen.

The research for the report Dietary Status Of Teens And Young Adults In Micronutrient Crisis shows that not only have the diets of teenagers and young adults been getting steadily worse over the past 10 years, but that increasing numbers of young people are now at risk of deficiency and several health problems.

Poor adolescent diets may influence heath issues such as bone disease in later life due to calcium deficiencies, brain health and behaviour in adulthood[1] due to lack of omega-3 fatty acids in the diet, weight and shape due to meal skipping and crash diets where there is serious limiting of food and elimination of food groups.

A group of leading healthcare professionals, including a nutritionist, a pharmacist and two GPs, assessed the latest evidence from the National Diet and Nutrition Survey, along with HSIS consumer research which looked at the dietary habits and the nutritional understanding of young adults.

Key nutrients for which young people are at risk of deficiency include vitamin A, vitamin D, iron, calcium, iodine and magnesium. For example, more than one in five (21 per cent) of 11-18-year olds had vitamin A intakes below the Lower Reference Nutrient Intake (LRNI) and more than half of teenage girls and a third of young women had iron intakes which failed to reach the LRNI, leaving them exposed to the risk of deficiency.

And a secondary analysis of data from years 1-6 of the NDNS[2] found that young adults in their twenties had significantly lower (p < 0.05) intakes of eight micronutrients, expressed as a percentage of the Reference Nutrient Intake, compared with adults in their thirties, forties and fifties (Vitamin A, Riboflavin, Folic acid, Calcium, Magnesium, Potassium, Iodine, Copper).

Yet the HSIS consumer research shows there is a disconnect, with most scoring young people’s diets at least 7 out of ten for healthiness. Three quarters (74 per cent) recognise that nutrition supports academic performance, and 76 per cent say it’s important for mood.

The research also shows that seven out of ten have never heard of ultra-processed foods yet studies[3] show that these highly processed, nutrient-poor foods and drinks provide around 60 per cent of daily calories in the UK.

Co-author of the report, GP Dr Gill Jenkins says: “The teenage years are a key life stage for physical and mental development so having the correct intakes of vitamins, minerals and healthy fats is crucial. For example, bone density peaks in early adulthood – insufficient levels of vitamin D, calcium and magnesium at this time puts this at risk, leading to weaker bones later in life.”

Co-author, GP Dr Nisa Aslam, adds: “Considering that many young people don’t eat enough fruit, vegetables, fibre-rich foods and oily fish, and gravitate towards so-called ultra-processed foods, high in calories, fat, salt and sugar, it’s surprising that respondents to the HSIS poll still give young people’s diets the thumbs up. Parents are simply unaware that their offspring are eating badly, while young people themselves are more interested in the taste of foods than their nutritional value.”

In conclusion, Dr Gill Jenkins says: “Poor diets in teenagers and young adults are a cause for concern – particularly as the situation is getting worse, not better. Good nutrition is vital for future health and mental wellbeing. Diets must be improved but are unlikely to change quickly enough. In the meantime, a daily multi-vitamin and multi-mineral plus a fish oil supplement should be recommended for all teenagers and young adults.”

NOTES TO EDITOR:

The report in summary

More than one in five (21 per cent) of 11-18-year olds had vitamin A intakes below the minimum needed for good health – called the Lower Reference Nutrient Intake (LRNI). Vitamin A is important for eye and skin health, as well as immune function.
Intakes of key B vitamins – needed for energy release and the functioning of blood cells – were low for many young people. A quarter of girls (13 per cent of boys) had riboflavin (vitamin B2) intakes below the LRNI, with blood samples indicating poor riboflavin status in more than 70 per cent of teenagers. For folate, 15 per cent of girls had intakes below the LRNI and around a third showed early signs of clinical deficiency by having low levels of red blood cell folate.
Folate is key for the health of unborn children – deficiency increases the risk of birth defects such as spina bifida. Therefore, it’s vital for girls – as the next generation of mothers – to have adequate folate in the diet. Folate is found in green leafy vegetables, liver, orange juice and fortified breakfast cereals. Folic acid supplements are recommended in early pregnancy but only 6 per cent of young women take them at the correct time[4].
The nation’s lack of vitamin D has been laid bare during the COVID crisis. Not only vital for the immune system, vitamin D plays a role in bone health and muscle function. Intakes of vitamin D amongst teenagers are just a fifth of that recommended (~2 micrograms vs. 10 micrograms). Current government guidance is for everyone to take a daily vitamin D supplement, while experts have been warning of the need to boost vitamin D status to ensure optimal immune function as we live through COVID.
Iron is essential for transporting oxygen around the body and supporting both immune health and cognitive function. Children and young women are more at risk of low iron levels – leading to tiredness, loss of concentration and fatigue. More than half of teenage girls and a third of young women had iron intakes which failed to reach the LRNI, leaving them exposed to the risk of deficiency. Iron intakes are lower today than a decade ago, possibly due to the trend to give up red meat – one of the best dietary sources of this mineral. Looking at blood samples, a quarter of teenage girls and 12 per cent of women had low iron stores while one ten were clinically deficient.
Apart from vitamin D, calcium and magnesium are important for bone health – working together to establish a strong, dense bone structure for life. Magnesium also supports the normal functioning of the nervous system. Around 10-15 per cent of teens and young adults had inadequate intakes of calcium, and there was evidence of a downward trend, since 45 per cent more teenagers had intakes below the LRNI compared with 2008-09. For magnesium, half of teenage girls and a third of boys had intakes below the LRNI.
Other nutrients of concern were potassium (normal blood pressure and muscle function), iodine (hormone regulation), selenium and zinc (both vital for normal immune function). Further details are in Table 3 of the report.

[1] https://www.sciencedaily.com/releases/2017/06/170619134058.htm

[2] Derbyshire E (2018) Micronutrient Intakes of British Adults Across Mid-Life: A Secondary Analysis of the

UK National Diet and Nutrition Survey. Front. Nutr. 5:55. doi: 10.3389/fnut.2018.00055

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830631/

[4] PloS One (2014) 9(2): e89354.

µg	Microgram a measurement of weight equal to one millionth of a gram (or one thousandth of a milligram). Microgram (µg or mcg) is used for a number of nutrients found in food supplements.
Amino Acid	The building blocks of protein, there are eight essential amino acids which cannot be synthesised within the body and therefore must come from the diet. These are: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. In addition arginine and histidine are amino acids required by infants and young children which supports their rapid growth.
Antioxidant	A substance or nutrient which helps to protect our cells from damage caused by free radicals, damaging molecules which are found in pollution and tobacco smoke. Our bodies also produce free radicals as part of the normal biochemistry of living.
Deficiency	A lack of essential macronutrients or micronutrients which results in malnutrition and or disease. This may be the result of inadequate intakes or absorption issues associated with gastrointestinal disease. There are a number of recognised deficiency diseases including (but not exclusively): scurvy (vitamin C deficiency); rickets (vitamin D deficiency); anaemia (iron deficiency, but also deficiencies in B12 and folic acid) and Kwashiorkor (protein deficiency).
DH	The Department of Health is a UK Government department. It has responsibility for nutrition legislation and sets health policy for nutrition.
DHA	Docosahexaenoic acid; one of the key omega-3 fats that provides health benefits
Dietitian	An individual qualified in nutrition and dietetics who can assess, diagnose and treat health issues associated with nutrition and diet. Dietitians are governed by law with a statutory code of practice; they often work within the health service although increasing numbers are also working in a freelance capacity.
EFA	Essential fatty acids (omega 3 and omega 6) cannot be synthesised by the body and must be derived from the diet. EFAs do not provide fuel for energy production and are required for vital biological processes which support growth, development and health.
EFSA	European Food Safety Authority; the European Union food risk management agency which scientifically evaluates safety across all areas of food.
EPA	Eicosapentaenoic acid; one of the key omega-3 fats that provides health benefits.
Fat soluble vitamin	The fat soluble vitamins are vitamins A, D, E and K. Because they are fat soluble these substances can accumulate in the body, often being stored in fat cells, or in the liver. This can create health issues, particularly if intakes have been high for a prolonged period of time. For example, long term high intakes of vitamin D may lead to the laying down of calcium in tissues such as liver and kidneys which can cause nausea and vomiting.
Food supplement	A food supplement is a concentrated source of vitamins, minerals or other substances with a nutritional or physiological effect which is sold in small, measured unit doses.
FSA	The Food Standards Agency is a non-ministerial UK Government department responsible for food safety and food hygiene.
GLA	Gamma-linoleic acid is an omega-6 fatty acid (an essential fatty acid considered to be necessary for human health which must be derived from the diet). GLA is most commonly found in evening primrose oil (EPO), borage or starflower oil and blackcurrant seed oil.
Health claim	A health claim is any claim which states, or implies, that consumption of a specific food will have a beneficial effect on health. Claims may be written, verbal or pictorial.
Herbal medicine (herbal remedy)	A product is considered to be a herbal medicine if the main active ingredient/s are only herbal substances or preparations. Not all herbal products are medicines, some may be food supplements and some may be cosmetics. What determines if a product is, or is not a medicine is complex but generally rests with how the product is presented (i.e. does it make medicinal claims to treat, prevent or cure any disease) and what it does (i.e. does it have a physiological impact on, or alter, any body functions).
Macronutrient	Dietary constituents which are needed in significant amounts, generally protein, fat, carbohydrate, fibre and water.
Malnutrition	Malnutrition is a state in which the deficiency of nutrients such as energy, protein, vitamins or minerals results in measurable adverse effects on the body. Malnutrition may refer to insufficient intake of protein, carbohydrate and fats (macronutrients) which can result in overly low BMI. It may also be insufficient intake of vitamins, minerals and other micronutrients, which can impact on overall health and could include obese individuals with poor diets.
Mg	Milligram is a measurement of weight equal to one thousandth of a gram. Mg is used for a number of nutrients found in food supplements.
Micronutrient	A substance derived from food which is needed in extremely small amounts for the normal growth and development of living beings. Micronutrients are vitamins, minerals and essential fatty acids (omega-3 fats)
Mineral	Inorganic micronutrient essential to health and wellbeing. Minerals are absorbed from soil by plants which are in turn eaten by animals or humans. Minerals may be split into minerals which are needed in relatively high amounts (calcium, phosphorus, magnesium, sodium, chloride and potassium) and trace elements (iron, zinc, cobalt, copper, chromium, fluoride, iodine, manganese, molybdenum, boron and selenium) which are needed in very small quantities.
Multivitamin	A product which contains more than one vitamin, often multivitamins will contain all 13 vitamins although some may contain only the eight B vitamins, or a combination of some of the vitamins and some additional minerals.
NDNS	The UK National Diet and Nutrition Survey is a continuous rolling survey of the dietary habits and nutritional status of adults and children in the UK. The results are used to assess whether intakes of food and nutrients are adequate across different ages and population groups.
NRV	Nutrient Reference Value is the amount set by the European Food Safety Authority (EFSA), primarily to support food labelling, which the majority of the population requires to maintain health. Previously known as RDA
Nutrient	A substance derived from food which provides nourishment to the body and is essential for the maintenance of life and for growth and development.
Nutritionist	Nutritionists generally work for public bodies or governments, although some do work with private clients. They tend to look at large populations to determine risk factors and make dietary recommendations that are applied at population levels. For example, evidence on the incidence of type II Diabetes led public health nutritionists to determine that some populations are more at risk of developing this disease, and to make recommendations for dietary changes to either reduce the risk or manage the disease. However, public health nutritionists do not practice with individual patients.
Omega-3 fats	Essential fatty acids which cannot be synthesised by the body and must be derived from the diet. Primary sources for omega-3 fats are oily fish and fish oil supplements with some also coming from enriched eggs and fortified foods. There are a number of scientifically proven health benefits for omega-3 fats including supporting the health of the eyes, brain and heart, maintaining an appropriate balance of triglycerides in the blood and reducing blood pressure.
Omega-6 fats	Essential fatty acids which cannot be synthesised by the body and must be derived from the diet. Primary sources for omega-6 are vegetable oils such as sunflower and corn oils as well as nuts and seeds. There are a number of health benefits associated with omega-6 fatty acids; they are thought to be beneficial in the management of premenstrual syndrome and in some skin conditions including eczema and psoriasis.
PAGB	Proprietary Association of Great Britain (PAGB) is the UK trade association which represents the manufacturers of branded over-the-counter medicines, self care medical devices and food supplements.
Prebiotics	Foods which promote the growth of probiotics, the beneficial bacteria that inhabit our gut. Prebiotics are generally fibres such as inulin, which our bodies cannot digest and absorb but which provide a food source for probiotics.
Probiotics	Live bacteria (and some yeasts) which inhabit the digestive tract which are viewed as being beneficial to human health. There are thousands of different bacterial strains; some are resident in specific areas of the digestive tract whilst others are transient, simply passing through.
Public Health England (PHE)	Public Health England is an agency of the Department of Health responsible for improving public health. They work with local government, the NHS and non-governmental organisations as well as communicating public health messages to the general public.
PUFA	Polyunsaturated fatty acids (PUFA) are found in nuts, seeds, fish (and fish oil), krill and some algae, small amounts are also found in leafy greens. The omega-3 and omega 6 fats are PUFAs, which are generally associated with health.
RDA	Recommended Daily Amount; previously used terminology for the amount set, primarily to support food labelling, which the majority of the population require to maintain health. Now described using nutrient reference value (NRV)
SUL	Safe Upper Levels of vitamins and minerals were established by the Expert Group on Vitamins and Minerals who published a report in 2003 (https://cot.food.gov.uk/sites/default/files/cot/vitmin2003.pdf). The UK food supplements industry works to the levels set in this report.
Vitamin	Organic micronutrient essential to health and wellbeing. Vitamins cannot be synthesised in sufficient amounts by the animal or human body and must therefore be obtained from the diet. Plants manufacture vitamins which move up the food chain as the plants are consumed by animals or humans. Vitamins can be divided into fat soluble (vitamins A, D, E and K) and water soluble (vitamins B1, B2, B3, B5, B6, B12, biotin, folic acid and vitamin C).
Water soluble vitamin	The B vitamins and vitamin C are water soluble. They are not stored in any significant quantities within the body and are generally either utilised or excreted in the urine. As they are not stored in the body, they tend to have low toxicity and are needed on a daily basis.