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There are several segments of our population that may not be "healthy" and that may be considered to be "at risk" for inadequate nutrient intake. The RDAs do not take into account the special needs of these people. The greater requirements of the groups listed in Table 6.5 need to be recognized and addressed.

Alcohol Drinkers

Approximately 90 million Americans drink alcoholic beverages, and 10 million of these are considered to be alcoholics.30 Heavy alcohol consumption has been shown to adversely affect levels of beta-carotene, folic acid, thiamine, riboflavin, niacin, vitamin C, vitamin Вб, vitamin B12, magnesium, and zinc. Consuming three or more drinks a week can lead to deficiencies of these nutrients.


There are 50 million cigarette smokers in the United States. Studies have shown that the plasma level of vitamin С in heavy smokers maybe 40 percent lower than in nonsmokers.45"48 The levels of other anti

oxidants, like beta-carotene, vitamin E, and В6, have been shown to be low as well.


An estimated 40 or 50 million Americans are dieting at any given time. In some age groups of women, this figure is even higher than 50 percent of the total female population. Whenever the dieter's total caloric intake drops below 1,400 calories a day, it is almost impossible to obtain most vitamins and minerals in adequate amounts. Your vitamin requirements remain the same despite your caloric intake, even during total fasting. Hence, dieters not taking supplemental vitamins and minerals are at risk for nutrient deficiency. Dieting in the form of skipped meals or fad diets is common in the United States and almost guarantees inadequate intakes of vitamins and minerals without supplementation. None of eleven published reducing diets provides 100 percent of the U.S. RDA for vitamins.

People With Chronic Illnesses

There are an estimated 31 million people in this country with serious chronic illnesses. This group is "at risk" for inadequate nutrient intake because of interactions of medications with micronutrients or because of the effects of various diseases themselves, like cancer. The incidence of these chronic illnesses increases yearly, especially cancer, with about one million new patients developing cancer every year. About 36 million people are hospitalized yearly, and the nutritional status of seriously ill hospitalized patients is very poor. Their disease or injury increases their nutritional needs, which can precipitate malnutrition and impair the immune system.

People Undergoing Surgery

There are 23.5 million patients who undergo surgery every year, and their nutritional status is compromised by the trauma of surgery. Some operations interfere with the ingestion, digestion, and absorption of food as well. Trauma and wound healing require that you take certain nutrients in amounts exceeding the RDA.

People With Infections

Approximately 5 million patients are in the hospital yearly with infections. The majority of these patients have little or no appetite and a marked reduction in food intake. The tenth edition of the U.S. RDA states, "Infections—even mild ones—increase metabolic losses of a number of vitamins and minerals." In addition, acute or chronic infections of the gastrointestinal tract impair the absorption of nutrients.

The Elderly

There are a little over 25 million elderly citizens in the United States, and this segment of the population is growing. Various factors affect their nutritional health. Nutritional problems in this age group occur mainly as a result of decreased caloric intake, impaired absorption, poor dentition, drug/nutrient interactions, limited activity or handicap, low income, altered taste perception, loneliness, lack of transportation, or any combination of these. Nutrients most often identified as deficient in the elderly include calcium, vitamin Вб,thiamine, folate, riboflavin, niacin, vitamin С (to a point of unrecognized scurvy), and vitamin D.


There are approximately 17 million teenagers in our country, and the 1985 USD A Nationwide Food Consumption Survey indicated that the diets of adolescent girls who consume foods that satisfy less than 70 percent of their energy requirements met the RDA requirements for only one of twelve nutrients studied—and that was protein, not any of the vitamins or minerals. The prevalence of nutrient deficiencies in female teenagers may result from constant dieting for weight control. Iron, magnesium, and vitamin С were identified as problem nutrients among 20 to 40 percent of male teens studied. Folate and vitamin A were also found to be deficient in a significant number of adolescents. Many teenagers skip meals, snack, and often eat meals away from home. About 50 percent of all teenagers report that they are not concerned about nutrition, and only 33 percent say that they try to eat correctly. Many favor junk foods and soft drinks.


Another group that has an increased need for some nutrients is the estimated 11 million diabetics in the United States. Diabetics have low levels of thiamine82 and other В vitamins, vitamin C, and vitamin

Pregnant and Lactating Women

Substantial numbers of American women have demonstrated marginal intakes of vitamin A, vitamin C, vitamin B6, calcium, iron, and magnesium.84 Pregnant and lactating women require nutrients in greater amounts than the RDA. Unfortunately, these women do not have a sufficient intake. In healthy pregnancies, at the time of delivery, 25 percent of mothers had at least one nutrient deficiency.

Premature Infants and Toddlers

Babies and toddlers are also at risk for nutrient deficiencies. Premature infants have low levels of vitamins A, C, and E. The USDA Nationwide Food Consumption Survey showed that iron and vitamin С were problem nutrients among infants and youngsters. Vitamins A and С were insufficient among many children aged 1 -5 in the HANES I study, and children aged 1-5 were shown to be at greater risks for niacin insufficiency in the HANES II study.

Low-Income People

Low-income populations have been shown to have deficiencies of vitamin C, thiamine, riboflavin, niacin, and iron. Those who bought food with food stamps had 10 to 20 percent lower amounts of eleven nutrients studied than households not needing food stamps. Only 12 percent of those with food stamps met the RDA criteria for all eleven nutrients. Spanish-Americans have been shown to have a deficiency of vitamin A, a state that is probably due to insufficient vitamin A food sources in their cultural diet. And, as was stated before in the Ten State survey and HANES I Survey, vitamins A and C, riboflavin, niacin, and iron were problem nutrients among lower income blacks.

Stressed People and Osteoporosis Patients

Countless millions of Americans also have an increased nutrient need because of stress. As recommended by the ninth edition of the RDA in 1980, you should increase your intake of various nutrients when you are under stress. Approximately 34 million people have osteoporosis, a condition that also necessitates a larger intake of many nutrients.

Users of Medications and Oral Contraceptives

Another segment of the population at risk for nutrient deficiencies is the millions who use therapeutic drugs that directly interfere with nutrient levels. Very common drugs such as laxatives and mineral oil deplete your body of fat-soluble vitamins; aspirin impairs the utilization of vitamin С and folic acid; and oral contraceptives deplete your body of folic acid, vitamins В6, B12, and C, and beta-carotene. A recent article in the British Medical Journal reviews the entire subject, and well over fifty to sixty commonly used drugs are listed as interfering with vitamins and minerals; hence, these drugs increase your micronutrient requirements.

Children With Low IQs

One of the most exciting areas of nutrient investigation is that of intelligence quotient. Many studies have been conducted on the effects of nutrients on intelligence. When children's diets were supplemented with vitamins and minerals, their IQs were raised. The implication is obvious: the marginal deficiencies seen in some young children are enough to hamper neural function in these children. Other studies have shown that marginal vitamin and mineral deficiencies are associated with poor motivation, abnormalities in attention and perception, and personality changes.