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Population-Level Changes in Folate, Iodine, and Vitamin D Status over More than 20 Years: Biomarker Data from the
Christine M Pfeiffer1, Maya R Sternberg1, Carissa D Powers1
1Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Division of Laboratory Sciences, Atlanta, GA, United States.
Background:
The National Health and Nutrition Examination Survey (NHANES) has monitored biomarkers for 4 key nutrients important for pregnancy outcomes, neurological development, and healthy growth-folate, vitamin D, iodine, and iron-during most survey cycles from 1999 to 2000 through August 2021-August 2023 as part of the continuous NHANES. These biomarker data offer a unique opportunity to assess long-term trends in the US population.
Objectives:
This study aimed to describe concentration trends for 7 biomarkers/indicators after adjusting for demographic changes over time.
Methods:
We used the following NHANES data: serum folate (SFOL) and red blood cell folate (RBF) for persons aged ≥3 y and women of reproductive age (WRA, 12-49 y) for 1999-August 2023 (except 2017-2018), serum 25-hydroxyvitamin D (25OHD) for persons aged ≥3 y for 2001-August 2023, urine iodine (UI) for persons aged ≥3 y for 2001-2018, and serum ferritin [(FER) and FER adjusted for inflammation (FERadj)], serum soluble transferrin receptor, and body iron index (BII) for WRA and children aged 1-5 y for 2003-August 2023 (except 2011-2014). We assessed trends as overall concentration change using logistic regression (unadjusted and adjusted for age, sex, and race and Hispanic origin) and as a linear trend if the overall change was significant.
Results:
After adjusting for demographic changes, mean concentrations of all 7 biomarkers/indicators showed significant overall temporal changes (except for FER in children and BII in WRA) and significant linear trends (except for FERadj in children). SFOL (∼25%-30%), RBF (∼10%), and UI (∼25%-30%) concentrations decreased, whereas 25OHD (∼20%) concentrations increased. FER concentrations decreased in WRA (∼15%) and remained unchanged in children.
Conclusions:
Considering the long monitoring period, biomarker changes were moderate. Nonetheless, these changes highlight the need to address declining iodine, iron, and folate status in WRA and increasing vitamin D status in supplement users.
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