¿Cómo comen los argentinos? Consumos, brechas y calidad de dieta / How do argentines eat? Consumption, gaps and diet quality

Resumen El objetivo del trabajo fue analizar los consumos alimentarios de la población argentina, identificar sus principales brechas alimentarias, determinar su magnitud e intensidad y analizar la calidad de dieta resultante. Se trabajó con la base de datos de la Encuesta Nacional de Gastos de los Hogares (ENGHo) 2017/2018. Se extrajeron y analizaron registros de compras de 383 alimentos y bebidas; los consumos se expresaron en energía y nutrientes (tabla SARA) y se calcularon medidas de Índice de Densidad de Nutrientes (IDN) y brechas alimentarias con relación a las recomendaciones de una dieta saludable (brecha promedio, magnitud de hogares con brechas e intensidad de la brecha). El patrón alimentario hallado refleja consumos bajos en alimentos protectores y preventivos de enfermedades crónicas y monotonía de la dieta. Las brechas reflejan déficits (promedio 60%) en hortalizas no feculentas, frutas, legumbres, granos y cereales integrales y leche, yogur y quesos. Harinas y otros productos feculentos, alimentos ocasionales y carnes registran brechas excedentarias en hogares de todos los niveles de ingreso, excepto el 1° quintil en carnes y en alimentos ocasionales. Solo 11% de los hogares presenta una calidad de dieta alta. Todos los resultados hallados son peores en los quintiles de ingresos más bajos y en hogares con presencia de niños, niñas y adolescentes. Las principales conclusiones se refieren a la monotonía alimentaria, las amplias brechas, su magnitud e intensidad en los alimentos de mejor densidad nutricional y su expresión en una calidad de dieta apenas intermedia. El exceso y desequilibrio en la ingesta de alimentos fuente de hidratos de carbono, con un balance desfavorable hacia legumbres, granos y cereales integrales, así como el exceso de alimentos ocasionales y la necesidad de disminuir los altos consumos de carnes en amplios sectores de la población.

Abstract The objective of this research was to analyze the food consumption of the Argentine population, identify its main food gaps, determine its magnitude and intensity and analyze the resulting quality of diet. We analyzed the database of the National Household Expenditure Survey (ENGHo) 2017/2018. Purchase records of 383 food and beverages were extracted and analyzed; consumptions were expressed in energy and nutrients (SARA table) and Nutrient Density (IDN) measures and food gaps were calculated in relation to the recommendations of a healthy diet (average gap, magnitude of households with gaps and intensity of the gap). The dietary pattern found reflects low intakes of protective and preventive foods for chronic diseases and monotony of the diet. The gaps reflect deficits (average 60% ) in non-starchy vegetables, fruits, legumes, grains and whole grains, milk, yogurt and cheeses. Flour and other starchy products, occasional foods and meats register surplus gaps in households of all income levels, except for the 1st quintile in meats and occasional foods. Only 11% of households have a high quality of diet. All the results found are worse in the lowest income quintiles and in households with children and adolescents. The main conclusions refer to food monotony, wide gaps, its magnitude and intensity in foods with the best nutritional density and its expression in a barely intermediate quality of diet. The excess and imbalance in the intake of carbohydrates source foods, with an unfavourable balance towards legumes, grains and whole grains, as well as the excess of occasional foods and the need to reduce the high consumption of meat in large sectors of the population.

Nutrition education discouraging sugar intake results in higher nutrient density in diets of pre-school children

BACKGROUND/OBJECTIVES: The intake of sugar has increased worldwide, and it is well established that childhood experiences and food preferences affect lifelong eating habits. To discourage sugar intake, nutrition education was imparted, and the effectiveness of the nutrition education program was investigated by considering the nutrient density and major dietary sources of sugar intake. SUBJECTS/METHODS: Twenty four-hour dietary recall and sugar intake frequency of 96 pre-school children (educated n = 47; non-educated n = 49) were collected on 3 consecutive days (1 weekend day, 2 weekdays) after 11 weeks of imparting nutrition education. Dietary intake of nutrients and total sugar were analyzed, and the intake frequency of sugar source foods were identified. All nutrition education programs were focused on a hands-on education program, and consisted of cooking lab, play, activity, animation, and visual materials. The difference between the two groups was verified by the Chi-square test or t-test. All statistical analysis was performed with significance level at P < 0.05. RESULTS: Compared to the non-educated group, the intakes of protein (P < 0.001), fiber (P < 0.01), potassium (P < 0.05), iron (P < 0.05), zinc (P < 0.05), and iodine (P < 0.001) were significantly higher, and the intakes of carbohydrate (P < 0.01) and total sugar (P < 0.05) were significantly lower in the educated group. The cumulative percent of sugar intake of top 20 sugar source foods in the educated group (82.80%) was lower than that of the non-educated group (85.75%). The contribution of beverages on total sugar intake was lower in the educated group. The average frequency of consuming sugary foods was significantly lower in the educated group (P < 0.05). CONCLUSIONS: Our results indicate that nutrition education on discouraging sugar intake is effective in reducing the amount of total sugar consumed, resulting higher nutrient density in the diets of pre-school children.

Correlation of Coffee Consumption, Lifestyle, and Nutrient Density

This study evaluated the nutrient intake with increasing coffee consumption for 403 adults aged over 30 years in Korea. The 403 subjects were national health screening examinees, who visited Sahmyook Seoul Hospital's Comprehensive Check-up Center between 2017.11.01 and 2018.12.18. The subjects were asked to answer questionnaires covering a 24-hour recall fluid and dietary intake before the health examination. The research ethics council of Sahmyook University (2-7001793-AB-N-012019036HR) approved this study. Coffee consumption exceeding two servings daily was more likely in males, in those aged between 30 and 40 years, and in the smoking, drinking, non-exercise, non-breakfast groups compared to each counterpart. The correlation between the coffee consumption frequency and current nutrient density showed negative correlations in most micronutrients. The mean nutrient density decreased gradually with increasing coffee consumption (2 servings daily) in the ANOVA analysis. Therefore, the progressive adverse health effects of excessive coffee consumption needs to be researched further, and a daily total caffeine limit should be suggested in education of the nation levels.

Diseño de una canasta saludable de alimentos y criterios para una evaluación comparativa de precios y densidad de nutrientes / Design of a healthy food basket and criteria for a comparative evaluation of prices and nutrient density

Introducción: asegurar la asequibilidad de la población a una alimentación saludable requiere abordar la conformación y el seguimiento del valor de una canasta saludable de alimentos y de los precios diferenciales de alimentos según calidad nutricional. Objetivos: diseñar una canasta saludable de alimentos (CSA) que resulte consistente con las Guías Alimentarias para la Población Argentina (GAPA). Los objetivos específicos son la definición de un índice de calidad nutricional de alimentos y bebidas, la conformación de la CSA por grupos de alimentos, su valoración económica, y comparar la calidad nutricional y los precios de alimentos disponibles en el mercado. Metodología: el marco metodológico se basó en las GAPA y el concepto de densidad nutricional. Para definir el Índice de densidad nutricional (IDN) de alimentos se consideraron 9 nutrientes esenciales (proteínas, fibra, calcio, hierro, zinc, potasio, Vitaminas A, C y B9), 3 nutrientes críticos (azúcares, sodio y ácidos grasos saturados), el contenido de almidón, y las ingestas recomendadas del Institute of Medicine (IOM). Se elaboraron especificaciones sobre cantidades, variedad y calidades de alimentos para la CSA según grupo de alimentos. Los precios fueron registrados en comercios de la Ciudad y partidos aledaños de Buenos Aires. Resultados: al aplicar el IDN a un conjunto de 320 alimentos y bebidas consumidos por la población argentina, se los clasificó en tres terciles de calidad. El ordenamiento resultante es consistente con las recomendaciones de las GAPA. El valor de la CSA fue de $ 3759.- mensuales (marzo 2018) para la unidad de referencia de 2000 kcal. Al comparar las densidades de nutrientes y precios de los alimentos, hortalizas feculentas, huevo y legumbres son las categorías con mejor relación calidad nutricional/precio. Los alimentos de mejor calidad nutricional tienen un precio de $ 14.- por 100 kcal y los de calidad mínima $ 4,5.- Discusión: la CSA y el IDN son herramientas para orientar y evaluar políticas que promuevan una mejor calidad de dieta.

Introduction: ensuring the population's accessibility to a healthy diet requires addressing the conformation and monitoring of the value of a healthy food basket and the differential prices of foods following nutritional quality. Objectives: to design a healthy food basket (HFB) consistent with the recommendations given by Argentina's dietary guidelines (GAPA). The specific objectives were to define a nutritional quality index for foods and beverages, the composition of HFB by food group, assess values, and compare the prices and nutritional quality of foods available in local markets. Methods: the methodological framework was based on GAPA and the concept of nutritional density. To define the Nutritional Density Index (NDI) of food, 9 essential nutrients (proteins, fiber, calcium, iron, zinc, potassium, Vitamins A, C and B9), 3 critical nutrients (sugars, sodium and saturated fatty acids), the starch content, and the recommended intakes of the Institute of Medicine (IOM) were considered. Specifications were prepared on quantities, variety and qualities of food for the HFB, according to the food group. The prices were registered in shops in the City Centre (CABA) and neighboring municipalities of Buenos Aires. Results: when applying the NDI to a set of 320 foods and beverages consumed by the Argentine population, they were classified into three tertiles of quality. The resulting order is consistent with the recommendations of GAPA. The value of the HFB was $ 3759.- monthly (March 2018) for the reference unit of 2000 kcal. When comparing nutrient densities and food prices, starchy vegetables, eggs and legumes are the categories with the best nutritional quality / price ratio. The foods of better nutritional quality have a price of $ 14.- per 100 kcal and those of minimum quality $ 4.5.- Discussion: the HFB and NDI are tools to guide and evaluate policies that promote a better diet quality.

Development and validation of a nutrient profiling model for Malaysian older population

@#Introduction: Nutrient profiling is the science of ranking food based on the nutrient content that enables an individual to make healthier food choice without exceeding the daily energy recommendation. This study was aimed at developing and validating a nutrient profiling model for Malaysian older population. Methods: A total of six nutrient profiling models comprising different combinations of nutrients were developed. Each model was tested by scoring 94 food items in terms of 100 kcal and 100 g, and the Recommended Nutrient Intakes for Malaysian (2017) as the reference value. The scores in each model were correlated with energy density per 100 g of food. The best model to correctly rank food according to nutrient density was chosen for validation. Validation was done by comparing the healthiness classification of 174 food items as determined by Towards Useful Aging Food Nutrient Density Index (TUA FNDI) nutrient profiling model and the Malaysian Dietary Guidelines. Results: Models with sodium and total fat were better correlated with energy density. All six models were inversely correlated with energy density. TUA FNDI 9-2 model was chosen as the best model for validation. Overall, there was substantial agreement between TUA FNDI 9-2 model and the food-based dietary guidelines (κ=0.644, p=0.001). Conclusion: The inverse correlation between nutrient profiling models to energy density shows that foods with higher nutrient density contain lower energy. The validated TUA FNDI 9-2 model is recommended for older adults to make healthier food choices.

Evaluation of dietary intake in Korean adults according to energy intake from eating-out: Based on 2013~2014 Korea National Health and Nutrition Examination Survey / 한국영양학회지

PURPOSE: The objective of the present study was to evaluate nutrient and food group intakes in Korean adults according to energy intake from eating-out. METHODS: This study was a cross-sectional study based on the 2013~2014 Korea National Health and Nutritional Examination Survey, and study subjects were 5,186 males (2,151) and females (3,035) aged 19~64 years. Energy intake from eating-out was analyzed using the 24-hour dietary recall method, and groups were classified by quartile according to energy intake from eating-out. RESULTS: Subjects who had more energy intake from eating-out tended to be younger, highly educated, have a higher income, and have higher alcohol consumption. Total energy intake and fat intake density of the highest quartile group of energy intake from eating-out were higher than those of the other groups. However, fiber, vitamin B1, calcium, phosphorus, potassium, and iron intake density levels were significantly lower in the highest quartile group of energy intake from eating-out. The highest quartile group of energy intake from eating-out consumed significantly more meat and beverages compared to the other groups. In addition, regarding diet quality (Index of nutritional quality), significantly lower vitamin B1, calcium, phosphorus, and iron levels were observed in the highest quartile group of energy intake from eating-out compared to those in the other groups. CONCLUSION: In conclusion, in Korean adults, consumption of eating-out decreased dietary quality, including vitamin B1, calcium, phosphorus, and iron levels. Further studies are needed to confirm these findings.

Evaluation of nutrient intake and food variety by age in Korean adolescents: Based on 2010~2012 Korean National Health and Nutrition Examination Survey / 한국영양학회지

PURPOSE: This study was conducted to investigate the nutrient intake and food variety in Korean adolescents. METHODS: We analyzed 1,555 adolescents aged 12 to 18 years using data from the combined 2010~2012 KNHANES (Korean National Health and Nutrition Examination Survey). In this study, subjects were divided according to age group (12~14 y, 15~18 y). The nutrient intake, ND (nutrient density), food intake and food score from each food group, variety and food intakes of meals, DDS (dietary diversity score), and GMVFDO (grain, meat, vegetable, fruit, dairy and oil food group) were analyzed using data from the 24-recall method. RESULTS: The results showed that the 15~18 age groupskipped breakfast significantly more often than the 12~14 age group (p < 0.0001). The 15~18 age group consumed significantly higher quantities of fat per 1,000 kcal compared to the 12~14 age group (p = 0.0069). Regarding food variety, the 15~18 age group showed a significantly higher intake (p < 0.0001) and score (p < 0.0001) from beverages than the 12~14 age group, whereas the 15~18 age group showed a significantly lower intake (p = 0.0084) and score (p = 0.0253) from milk than the 12~14 age group. In addition, DDS in the 15~18 age group (4.33) tended to be lower than that of the 12~14 age group (4.44) (p = 0.0727). CONCLUSION: Proper dietary management regarding meal variety is needed for the 15~18 age group, and more systematic studies to investigate the meal variety roles of adolescents are required.

Dietary factors affecting bone mineral density in Korean rural postmenopausal women

This study was conducted to investigate dietary factors, bone status, and bone loss in postmenopausal women in rural areas. A total of 189 women participated in the follow-up study after two years. Radius, Tibia, and Phalanx SOS (Speed of Sound) was measured on two occasions 2 years apart by ultra-sonic-metry, and % body fat was measured by bioelectrical impedance analysis at the baseline and after 2years. Dietary intake data were collected 4 times at different season by 24-hour recall method, and then calculated as average. Bone density of radius decreased by 4.2% during the two year period. When the subjects were divided into three groups, by bone decline level during two years, the lowest bone loss group had higher potassium and vegetable intake than other groups. Age and calcium intakes showed significant correlation with bone decline rate at tibia. In multiple regressions, the baseline SOS, vitamin A, vegetables and eggs intakes were found to be significant factors for tibia bone decline. In conclusion, dietary factors, such as higher vegetable intake, seem to affect the changes in bone mineral density in more favorable way. Therefore, efforts are needed to enhance the access to nutritional care for rural elderly postmenopausal women.

Analysis of Meal Habits from the Viewpoint of Regularity in Korean Type 2 Diabetic Patients / 당뇨병

BACKGROUND: The regular meal pattern with consistent day-to-day calorie and carbohydrate intake is one of the most important determinants of good glycemic control in diabetes. This study was aimed to investigate the meal pattern and their relationships with total energy intake, nutrients intake and glycemic and lipid profile in type 2 diabetes. METHODS: 1,084 subjects were divided according to glycemic status into three groups: the diabetes (DM), dysglycemia (DG) and normal (N). The meal frequency (MF), meal interval (MI) and daily intake of total energy, macronutrient and micronutrient were estimated with the 24 hours dietary recall from the Korean National Health and Nutrition Examination Survey (KNHANES) in 2001 and Eulji hospital. For analysis of meal pattern and it's relations with the nutrients intake, we regrouped into meal skipper (G1), non-meal skipper with unreasonable MI (G2), and non-meal skipper with reasonable MI (G3). RESULTS: 17.5% of DM, 21.8% of DG, 23.3% of N skipped at least one meal a day without significant difference across the groups. 55.9% of non-meal skipper had unreasonable MI. Meal was more regular in older age, lower educated person, employee, and female. G1 took higher fat, and more calories form snack and less micronutrient density, compared with G3 (P < 0.05). HbA1c, total cholesterol and triglyceride values were higher in G1 compared with other two groups (P < 0.05). CONCLUSION: Many type 2 diabetics had the irregular meal patterns, which was associated with poor glycemic control, lipid profiles and less micronutrient density. This suggested that another treatment strategy might be required for those who had irregular lifestyle.

Evaluation of Diet Quality according to Nutrient Intake between Highly Educated, Married, Unemployed and Employed Women

This study was conducted to provide foundation data for making health care policy for married women by assessing the dietary intake between highly educated married, employed and unemployed women. It is a direct interview, cross-sectional study with 24-hour recall method for one day. In selecting the subjects for this study, married, unemployed women were selected from a certain area (Daedeok Science Town) in Daejeon where there are high rates of highly educated women, and the married, employed women were selected from the teaching profession in order to avoid confounding due to including a variety of jobs. According to the Korean Standard Classification of Occupations, teaching is the representational occupation of highly educated, married women. Then, to prevent confounding due to age, we selected the subjects out of each age group at the same rate through random sampling. Women who had not graduated college, worked only part-time, or had no current spouse were excluded. As a result, 486 highly-educated, married, unemployed (250) and employed (236) women were used for analyzing data. The unemployed women consumed a higher amount of fat, cholesterol, sodium, vitamin C and folic acid while the employed women consumed a higher amount of iron, vitamin B1 and vitamin B2. P/M/S ratio being 1/1.18/1.05 and 1/1.05/0.87, for the unemployed women and the employed women, respectively, unemployed respondents had a higher saturated fat intake than those of employed. It is in excess of the standard ratio (1/1/1) of the Korean RDA. At the same time, in unemployed respondents the percent of energy intake from fat (24.8%, 23.2%) and animal fat (12.4%, 11.4%) were higher than those of employed respondents. The mean daily nutrient intake of calcium, zinc, and iron for both groups of respondents were lower than the Korean RDA. Both groups had phosphorus as the highest nutrient and calcium as the lowest nutrient of INQ (Index of Nutritional Quality) while nutrients with the INQ being less than 1 were calcium and iron. To sum up, the following conclusions can be made: Nutrition education and guidance for reduction of the intake of fat, especially animal fat, are necessary for unemployed women. In addition, highly educated, married, unemployed and employed women should increase the consumption of foods rich in iron and calcium to prevent anemia and osteoporosis, while decreasing the intake of phosphorus to balance proportions of calcium and phosphorus.

Nutrient Density of Fast-Food Consumed by the Middle School Students in Cheongju City / 대한지역사회영양학회지

The purpose of this study was to investigate fast-food consumption and it's nutrient density, and the correlation between subject's characteristics and consumption frequency of fast-foods among middle school students. The questionnaires were distributed to 150 male and 190 female students in Cheongju city. The data were analyzed using SAS and statistics used were percent of frequency, chi-test, t-test, and pearson's correlation coefficient. The main reasons for using fast-food restaurants were 'good taste' and 'convenience'. The major concerns when the subjects choose fast-foods were 'taste (65.9%), price (20.3%) and 'nutrition' (6.0%). The consumption pattern of fast-foods go as follows: twice a month (42.3%), once a week (31.5%), and less than once a week. The number of fast food items that the subjects ate for one meal was two (46.0%) or three (33.2%). The most frequently chosen combination of foods for number of two choices was beefburger and cola . The mean average energy intake from fast foods for one meal was 620.7 kcal for male, 504.5 kcal for female. The energy ratio of carbohydrate :protein :fat from fast foods was 49 :14 :43, which means fat intake is much higher than recommended level (20%). Fiber was appeared to be the lowest on the nutrient density which was 17.7% of the recommended level for Koreans, vitamin C was next (22.8% for male, 20.7% for female). In mineral, iron was the lowest (71.8% for male, 67.1% for female), and protein was over 100% for both males and females. Frequency of fast food intake was positively correlated with eating frequency of the salty, the sweets, ham, caffeine containing foods, instant noodles, and cookies. In conclusion, frequent consumption of fast foods can lead unbalanced nutrient intakes for middle school students, and those who consumed fast foods frequently showed undesirable food habits in their daily meal. Therefore, nutrition education for middle school students should be needed to encourage them to choose more nutritious food and have healthier dietary pattern.

Nutrient Density of Fast-Food Consumed by the Middle School Students in Cheongju City / 대한지역사회영양학회지

The purpose of this study was to investigate fast-food consumption and it's nutrient density, and the correlation between subject's characteristics and consumption frequency of fast-foods among middle school students. The questionnaires were distributed to 150 male and 190 female students in Cheongju city. The data were analyzed using SAS and statistics used were percent of frequency, chi-test, t-test, and pearson's correlation coefficient. The main reasons for using fast-food restaurants were 'good taste' and 'convenience'. The major concerns when the subjects choose fast-foods were 'taste (65.9%), price (20.3%) and 'nutrition' (6.0%). The consumption pattern of fast-foods go as follows: twice a month (42.3%), once a week (31.5%), and less than once a week. The number of fast food items that the subjects ate for one meal was two (46.0%) or three (33.2%). The most frequently chosen combination of foods for number of two choices was beefburger and cola . The mean average energy intake from fast foods for one meal was 620.7 kcal for male, 504.5 kcal for female. The energy ratio of carbohydrate :protein :fat from fast foods was 49 :14 :43, which means fat intake is much higher than recommended level (20%). Fiber was appeared to be the lowest on the nutrient density which was 17.7% of the recommended level for Koreans, vitamin C was next (22.8% for male, 20.7% for female). In mineral, iron was the lowest (71.8% for male, 67.1% for female), and protein was over 100% for both males and females. Frequency of fast food intake was positively correlated with eating frequency of the salty, the sweets, ham, caffeine containing foods, instant noodles, and cookies. In conclusion, frequent consumption of fast foods can lead unbalanced nutrient intakes for middle school students, and those who consumed fast foods frequently showed undesirable food habits in their daily meal. Therefore, nutrition education for middle school students should be needed to encourage them to choose more nutritious food and have healthier dietary pattern.

The Effects of Alcohol Intake on Nutritional Intake Status of College Students in Chungnam

The purpose of this study was to investigate the effects of alcohol intake on nutritional intake status among the college students. The subjects were divided three groups; no-alcohol group(n=78), alcohol group(n=113), and high-alcohol group(n=82) according to intake and frequency of alcohol. And they were observed characteristics of alcohol drinking, dietary behavior and attitude, and nutrient intakes using questionnaires. The frequency of skipping meals in breakfast in high-alcohol group were higher than in other two groups(p<0.01). There were no significant differences in frequency of skipping meals of lunch and supper, reason why skipped meals, and total score of dietary attitude among three groups. However, the score of dietary attitude about no heavy drinking and smoking in high-alcohol group was higher than in other two groups(p<0.01). There were significant difference in vitamin B2 intake, alcohol intake, and energy intakes from carbohydrate, lipid, and alcohol among three groups(p<0.05, p<0.05, p<0.01, p<0.05, p<0.05). Compared energy intake of high-alcohol group with other two groups, intake from carbohydrate was low and intakes from lipid and alcohol were high. In the nutrient density, plant protein and carbohydrate in no-alcohol group, lipid and vitamin B2 in alcohol group, and animal lipid in high-alcohol group were highest among three groups. NAR and MAR were not significant difference among three groups except that NAR of P in alcohol group is highest among three groups(p<0.05). In conclusion, students high consuming alcohol have unhealty dietary behaviors in the light of high frequency of skipping breakfast, undesirable dietary attitude of alcohol drinking and smoking, and low energy inake from diet. Therefore, this results should be considered in meal management and nutritional education for student of high alcohol consumption.

Elderly Nutrition Improvement Program in the community health center : Nutritional evaluation of the elderly using the Index of Nutritional Quality and food group intake pattern

Physiological changes that affect nutrient absorption and utilization occur in older adults, and the collection of nutritional information is an important part of examining the nutrition and health issue. A nutritional survey using the 24-hour recall method was performed to identify nutritional quality and leading patterns of food group intake for protein, vitamin C, P and Fe were over 1, whereas those for vitamin A, B1, B2, niacin and Ca were below 1. The MAR(Mean Adequacy Ratio) was relatively low(0.75). The percentage of energy from carbohydrate, protein, and fat was 65.1, 15.6, and 19.5, respectively, thus the quantities of energy source were ideal. The Older subjects revealed poorer nutrition quality than the younger subjects did. The food group intake pattern of the elderly was not diverse, only 9% of them consumed all food groups in a day. These results suggest that nutritional guiflines for older Koreans should focus on the maintenance of adequate energy intake. In addition, selection of foods with high protein and calcium, such as dairy food, should be emphasized, particularly in the older elderly. Nutrition programs should target individuals at risk of not receiving enough nutrients, like the oldest elderly, and persons with lower education.