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Home / What Percent of Total Calories Should Come From Fat

What Percent of Total Calories Should Come From Fat

Calories

Target: Caloric intake matched to individual needs and appropriate to achieve and maintain desirable body weight.

All the national organizations issuing dietary guidelines include recommendations regarding calorie intake and body weight. The American Cancer Society (1984); the National Research Council's Committee on Diet, Nutrition, and Cancer (National Research Council, 1982); and the U.S. Senate Select Committee on Nutrition and Human Needs (1977) all advise a calorie intake that would avoid obesity. The American Heart Association (1986), the National Institutes of Health (1984b) consensus development conference statement, and the U.S. Department of Agriculture (USDA)/U.S. Department of Health and Human Services (DHHS) (1985) recommend calorie intake to maintain desirable body weight, while the National Research Council's Committee on Recommended Dietary Allowances (National Research Council, 1980) suggests a calorie intake adequate to meet individual needs based on sex, age, and level of physical activity. This committee accepts as a target level a caloric intake matched to individual needs and appropriate to achieve and maintain desirable body weight.

Dietary Survey Data

Estimates of caloric intake from dietary survey data can be unreliable because respondents tend to underreport this variable (U.S. Department of Agriculture/U.S. Department of Health and Human Services, 1986). The Joint Nutrition Monitoring Evaluation Committee of the USDA and DHHS stated that ''if reported diets represent usual food energy intakes and such a large proportion of the population is overweight, it must be concluded that many Americans are underactive'' (U.S. Department of Agriculture/U.S. Department of Health and Human Services, 1986). The report Promoting Health/Preventing Disease: Objectives for the Nation (U.S. Public Health Service, 1980) recommended that by 1990, at least 60 percent of American adults ages 18 to 65 should participate in regular physical exercise; at present, this figure is only about 10 to 20 percent (Powell et al., 1985).

Summary

Data from the 1976-1980 National Health and Nutrition Survey (NHANES) indicate that approximately 34 million U.S. adults are obese (body mass index >85th percentile), of which 12.4 million are severely obese (body mass index >95th percentile). The incidence of obesity varies widely according to age and sex, with black adults ages 45-54 having the highest incidence (61.2 percent for females and 41.4 percent for males) (Table 3-1). Childhood obesity is more difficult to estimate but may range from 4 to 14 percent among low-income populations (Table 3-2).

TABLE 3-1. Obese Individuals, 1976-1980 (in percent).

TABLE 3-1

Obese Individuals, 1976-1980 (in percent).

TABLE 3-2. Percentage of Low-Income Children Screened with Weight-for-Height Above the 95th Percentile, 31 States, United States, 1984.

TABLE 3-2

Percentage of Low-Income Children Screened with Weight-for-Height Above the 95th Percentile, 31 States, United States, 1984.

Total Fat as Percentage of Calories

Target: Thirty percent or less of calories from fat for adults.

Excesses of the first four nutrients identified by the Joint Nutrition Monitoring Evaluation Committee (JNMEC) (calories, total fat, saturated fatty acids, and cholesterol) have all been implicated, either directly or indirectly, in the etiology of cardiovascular disease. Despite a 2 percent annual decline in its prevalence since 1968, cardiovascular disease remains the leading cause of death in the United States (Centers for Disease Control, 1986a).

Influence of Dietary Fats on Serum Lipid Levels

The type and amount of fat in the diet have become increasingly recognized as factors influencing nutritional status and overall health, as evidenced by numerous clinical studies (Grundy, 1986; O'Brien and Reiser, 1980; Reiser et al., 1985). It should be remembered that fat contributes about 9 calories/gram, more than twice as many as protein or carbohydrate (about 4 calories/ gram each). In addition, different fatty acids of dietary fats can significantly alter serum lipid levels. In general, saturated fatty acids raise the serum cholesterol level (certain exceptions were discussed in Chapter 2). Furthermore, monounsaturated fatty acids have been shown to lower cholesterol levels relative to saturated fatty acids. The monounsaturated fatty acids produce reductions similar to those induced by polyunsaturated fatty acids (Becker et al., 1983; Mattson and Grundy, 1985). Recently, eicosopentaenoic and docosohexaenoic acids (found mainly in fish) have generated considerable scientific and public interest. Studies have shown that they may reduce platelet aggregation and lower serum triglyceride levels (Herold and Kinsella, 1986).

Dietary Fat and Cancer

Some estimates indicate that nearly three-fourths of all cancers in the United States may be influenced by diet (Doll and Peto, 1981). Both animal experiments and epidemiological studies have shown an association between dietary fat and the incidence of cancer, particularly of the breast. prostate, and large bowel (Doll and Peto, 1981). The National Research Council's Committee on Diet, Nutrition, and Cancer cited that of all the dietary components it studied, "the combined epidemiological and experimental evidence is most suggestive for a causal relationship between fat intake and the occurrence of cancer" (National Research Council, 1982). It further concluded that epidemiological studies and animal experiments "provide convincing evidence that increasing the intake of total fat increases the incidence of cancer at certain sites, particularly the breast and colon, and, conversely, that the risk is lower with lower intakes of fat" (National Research Council, 1982).

Dietary Guidelines for Total Fat Intake

All national health organizations agree that total dietary fat intake should be reduced by some or all members of the U.S. population (depending on how much fat they currently consume) to maintain health and optimal body weight and to reduce the risk of certain diseases, particularly cardiovascular disease and perhaps cancer. Several groups have qualified their recommendations, directing their advice to modify dietary fat intake to particular segments of the population. Other groups have focused their recommendations more generally. The National Research Council's Committee on Diet, Nutrition, and Cancer (National Research Council, 1982), a National Institutes of Health (1984b) consensus development conference statement, and the American Cancer Society (1984) have all recommended that fat intake not contribute more than 30 percent of total calories. Since 1968, the American Heart Association (1968, 1982, 1986) has recommended that 30 to 35 percent of total calories come from fat and has recently revised this recommendation to be less than 30 percent. Likewise, the National Research Council's Committee on Dietary Allowances (National Research Council, 1980) suggests a fat intake not to exceed 35 percent of calories, especially in diets of less than 2,000 total calories. The Committee on Nutrition of the American Academy of Pediatrics (1981) suggests that dietary fat not be restricted for children under I year of age; after this age, a decrease in the consumption of saturated fatty acids, cholesterol, and salt and an increased intake of polyunsaturated fatty acids should be followed with moderation. For the purposes of this report, the committee has accepted, for adults, the target level of 30 percent or less of calories from fat.

Dietary Survey Data

The average percentage of calories from fat for the entire 1977-1978 National Food Consumption Survey (NFCS) population was 41 percent (U.S. Department of Agriculture/U.S. Department of Health and Human Services, 1986). This percentage is recognized as a high estimate for 1987 because of dietary changes that have occurred and the neglect by many respondents in the survey to report that fat on meat was not eaten. The 1977-1978 data imply an average need across the general population for an 11 percent reduction in the percentage of calories from fat, from the present 41 percent to the target level of 30 percent. While it is useful to note this as a general target level, it is important to focus on individual population subgroups, for which the 1977-1978 NFCS provides data. Some subgroups are at or near this 30 percent target level; others exceed it by a wide margin. Recommended alterations in eating habits vary greatly, depending on how large a reduction is necessary. A summary of the distribution of individuals from the 1977-1978 NFCS by population subgroups and by percentage of calories from fat in the diet and the reductions needed to meet the target level are given in Table 3-3; comparable data from the 1985 Continuing Survey of Food Intake by Individuals (CSFII) are given in Table 3-4.

TABLE 3-3. Distribution (Percent) of Individuals by Percentage of Calories from Fat and Reductions Needed to Meet Target Level.

TABLE 3-3

Distribution (Percent) of Individuals by Percentage of Calories from Fat and Reductions Needed to Meet Target Level.

TABLE 3-4. Distribution (Percent) of Women and Children by Percentage of Calories from Fat and Reductions Needed to Meet Target Level.

TABLE 3-4

Distribution (Percent) of Women and Children by Percentage of Calories from Fat and Reductions Needed to Meet Target Level.

The percentage of calories from fat in 1985 was below the 41 percent level reported in the 1977-1978 survey, as evidenced by data from the 1985 CSFII. Among children ages i to 5, the percentage of calories from fat was 34 percent (U.S. Department of Agriculture, 1985). For women ages 19 to 50, the percentage of calories from fat was 37 percent; for men ages 19 to 50, the percentage of calories from fat was 36 percent (U.S. Department of Agriculture, 1985, 1986). The Nutrition Monitoring Division of the Human Nutrition Information Service within the USDA (U.S. Department of Agriculture, 1985) has suggested that some of the differences between 1977 and 1985 may have been due to changes in food selections, such as the shift from whole milk to low-fat milk, as well as to changes in the way data were collected (for example, more probing questions were asked about the intake of fat on meat and skin on poultry and the use of fat on vegetables).

Summary

Data from the 1985 CSFII indicate that the average percentage of calories from fat for adults ages 19 to 50 was 36 to 37 percent, 6 to 7 percentage points above the 30 percent target level. For children ages I to 5, the percentage of calories from fat was 34 percent. Data from the 1985 CSFII indicate that 15 percent of children ages 1 to 5 and 12 percent of women ages 19 to 50 had diets meeting the target level (Table 3-4).

Saturated, Monounsaturated, and Polyunsaturated Fatty Acids as Percentage of Calories

Target: Ten percent or less of calories from saturated fatty acids, 10 percent or less of calories from polyunsaturated fatty acids, and 15 percent or less of calories from monounsaturated fatty acids for adults.

"Eating extra saturated fat, high levels of cholesterol, and excess calories will increase blood cholesterol in many people. Of these, saturated fat has the greatest influence," states the USDA/DHHS (1985) Dietary Guidelines for Americans. Elevated serum cholesterol levels, a major cause of cardiovascular disease, have been strongly correlated to several dietary factors, including a high intake of calories, certain saturated fatty acids, and cholesterol. Genetics and environmental factors may also play an important role in the development of high serum cholesterol. The 1979 Surgeon General's report on health promotion and disease prevention, Healthy People, stated that "premature heart disease is unequivocally associated with elevated blood cholesterol . . . heart attacks are five times as frequent in men and women aged 35 to 44 who have cholesterol levels above 265 (mg per dl) as among those with levels below 220 (mg per dl). In general, the lower one's blood cholesterol level the less the likelihood of heart disease; the higher the cholesterol level the greater the risk" (Office of the Assistant Secretary for Health and the Surgeon General, 1979).

Saturated Fatty Acids: Influence on Serum Lipid Levels

Saturated fatty acids are estimated to currently contribute about 13 percent of the total caloric intake of the average adult in the United States. These fatty acids, as a group, have been positively correlated with the prevalence of cardiovascular disease in many epidemiological studies (Hegsted et al., 1965; Keys, 1970; Stamler, 1979). Several specific saturated fatty acids have been shown to raise plasma levels of cholesterol and low-density lipoproteins, both of which are correlated with an increased risk of cardiovascular disease (Ahrens et al., 1957; Hegsted et al., 1965; Keys et al., 1965); lowering the level of saturated fatty acids in the diet will reduce the plasma cholesterol level (Hegsted et al., 1965; Keys et al., 1965).

Saturated fatty acids occur in both animal and plant fats. Particularly rich sources of saturated fatty acids from plants are coconut and palm oils. Animal fats contain saturated fatty acids of a wide range of chain lengths. Specific saturated fatty acids are believed to differ in their effects on plasma cholesterol. Three saturates—palmitic (C160), myristic (C140), and lauric (C120) acids—have been shown to raise the plasma cholesterol level, while stearic acid (C180), which is high in beef, lamb, and pork fat, apparently does not raise the plasma cholesterol level (Hegsted et al., 1965; Keys et al., 1965). The actions of the medium-chain fatty acids (C80, C100) on cholesterol levels are not well studied. As research confirms and refines the effects of stearic acid on the plasma cholesterol level, dietary recommendations may change to exclude this saturated fatty acid from the 10 percent calorie recommendation (Bonanome and Grundy, 1987).

Dietary Guidelines for Fatty Acid Intake

A "reduction" in saturated fatty acid intake or "avoidance" of excessive intakes, without citing specific levels, has been recommended by the USDA and DHHS (U.S. Department of Agriculture/U.S. Department of Health and Human Services, 1985), the National Research Council's Committee on Recommended Dietary Allowances (National Research Council, 1980), and the Surgeon General (Office of the Assistant Secretary for Health and the Surgeon General, 1979). Recommendations that intakes be reduced to less than 10 percent of total caloric intake have been made by the American Heart Association (1982) and a National Institutes of Health (1984b) consensus development conference statement; the U.S. Senate Select Committee on Nutrition and Human Needs (1977) suggested a range of 8 to 12 percent. This committee accepts, for adults, a target level of 10 percent or less of calories from saturated fatty acids.

Due to the unknown potential adverse effects of prolonged intakes of high levels of polyunsaturated fatty acids, the American Heart Association (1968) the National Institutes of Health (1984b), and the National Research Council's Committee on Dietary Allowances (National Research Council, 1980) have all cautioned against exceeding 10 percent of total calories from polyunsaturated fatty acids. This committee accepts, for adults, a target level of 10 percent or less of calories from polyunsaturated fatty acids.

The remainder of dietary fatty acids (15 percent of calories or less) should come from monounsaturated fatty acids, which are found in both animal and plant fats. The monounsaturated fatty acids have been shown in some studies to cause a lowering of serum cholesterol when exchanged for saturated fatty acids. They reduce low-density lipoprotein levels to about the same extent as do polyunsaturated fatty acids. There is no evidence that monounsaturates uniquely increase the risk for cancer. The committee accepts, for adults, a target level of 15 percent of calories or less from monounsaturated fatty acids.

Dietary Survey Data

Data from the 1985 CSFII indicate that saturated fatty acids, as percentage of calories, average about 13.2 percent in the diets of adults ages 19 to 50 and 13.9 percent for children ages 1 to 5 (Table 3-5). Data on 4-day intakes for women and children indicate that 10 percent of women (ages 19 to 50) and 4 percent of children (ages i to 5) had diets that met the target level for percentage of calories from saturated fatty acids (Table 3-6). Comparable data are not available for men, but the trend is thought to be similar.

TABLE 3-5. Calories from Fat and Fatty Acids, 1985 (in percent).

TABLE 3-5

Calories from Fat and Fatty Acids, 1985 (in percent).

TABLE 3-6. Distribution (Percent) of Women and Children by Percentage of Calories from Saturated Fatty Acids and Reductions Needed to Meet Target Level.

TABLE 3-6

Distribution (Percent) of Women and Children by Percentage of Calories from Saturated Fatty Acids and Reductions Needed to Meet Target Level.

Data from the 1985 CSFII indicate that monounsaturated fatty acids accounted for 13.5 to 13.8 percent of calories in the diets of adults ages 19 to 50 and 12.6 percent in the diets of children ages 1 to 5 (Table 3-5). Data on 4-day intakes indicate that 74 to 80 percent of children ages i to 5 and 64 to 66 percent of women ages 19 to 50 had diets that met the target level of 15 percent or less of calories from monounsaturated fatty acids (Table 3-7). Comparable data for men are not available, but the trend is thought to be similar.

TABLE 3-7. Distribution (Percent) of Women and Children by Percentage of Calories from Monounsaturated Fatty Acids and Reductions Needed to Meet Target Level.

TABLE 3-7

Distribution (Percent) of Women and Children by Percentage of Calories from Monounsaturated Fatty Acids and Reductions Needed to Meet Target Level.

Data from the 1985 CSFII indicate that polyunsaturated fatty acids accounted for 6.8 to 7.3 percent of calories in the diets of adults ages 19 to 50 and 5.5 percent of calories in the diets of children ages i to 5 (Table 3-5). Four-day intake data indicate that 98 to 99 percent of children ages 1 to 5 and 85 to 87 percent of women ages 19 to 50 had diets that met the target level for 10 percent or less of calories from polyunsaturated fatty acids (Table 3-8).

TABLE 3-8. Distribution (Percent) of Women and Children by Percentage of Calories from Polyunsaturated Fatty Acids and Reductions Needed to Meet Target Level.

TABLE 3-8

Distribution (Percent) of Women and Children by Percentage of Calories from Polyunsaturated Fatty Acids and Reductions Needed to Meet Target Level.

Summary

Data from the 1985 CSFII indicate that about 10 percent of women ages 19 to 50 and 4 percent of children ages 1 to 5 years had diets that met the target level for saturated fatty acids. Between 64 to 66 percent of women and 74 to 80 percent of children had diets that met the target level for monounsaturated fatty acids. About 98 to 99 percent of children and 86 percent of women met the target level for polyunsaturated fatty acids (Tables 3-6 through 3-8).

Cholesterol

Target: Three hundred milligrams or less of cholesterol per day for adults.

In some epidemiological studies, the risk of cardiovascular heart disease has been positively correlated to intakes of dietary cholesterol (Kannel et al., 1971; Shekelle et al., 1981). In one study, with intakes of up to about 400 mg/1,000 kcal, the plasma cholesterol response to dietary intakes of cholesterol was approximately linear: Each 1 mg/1,000 kcal resulted in a plasma cholesterol increase of about 0.1 mg/dl (Hegsted, 1986). Based on the results of that study, with a 2,500-kcal diet, an increase in dietary cholesterol of 100 mg/day would be expected to increase the plasma levels by about 4 mg/dl. Likewise, a decrease in dietary cholesterol of 100 mg/day would decrease plasma levels by about 4 mg/dl.

Dietary Guidelines for Cholesterol Intake

Reports from the USDA/DHHS (1985) and the Surgeon General (Office of the Assistant Secretary for Health and the Surgeon General, 1979) recommend a "reduction" in dietary intakes of cholesterol but do not cite precise levels. Organizations suggesting specific intakes include the U.S. Senate Select Committee on Nutrition and Human Needs (1977) (250 to 350 mg/day), the National Institutes of Health (1984b) consensus development conference statement (250 to 300 mg/day), and the American Heart Association (1986) ( Image img00003.jpg mg/day or 100 mg/1,000 kcal). Restriction of dietary cholesterol in children remains controversial, although a lowering of total dietary fat and an avoidance of obesity among this age group have been recognized as good preventive measures (Barness, 1986). This committee accepts, for adults, a target level for cholesterol of less than 300 mg/day.

Dietary Survey Data

Data from the 1977-1978 NFCS indicate that the average cholesterol intake for the survey population was 385 mg/day, or 214 mg/1,000 kcal (U.S. Department of Agriculture/U. S. Department of Health and Human Services, 1986). Fifty-eight percent of the survey population had intakes greater than 300 mg of dietary cholesterol per day. The highest intakes were among 19- to 64-year-olds, with 78 percent of the males and 52 percent of the females consuming more than 300 mg/day. These data are summarized in Table 3-9. Data on cholesterol intakes from the 1985 CSFII are presented in Tables 3-10 and 3-11. About 77 percent of children ages 1 to 5 and 62 percent of women ages 19 to 50 had diets that met the target level of <300 mg/day.

TABLE 3-9. Mean Daily Cholesterol Intakes in Relation to Target Level.

TABLE 3-9

Mean Daily Cholesterol Intakes in Relation to Target Level.

TABLE 3-10. Mean Daily Cholesterol and Calorie Intakes, 1985.

TABLE 3-10

Mean Daily Cholesterol and Calorie Intakes, 1985.

TABLE 3-11. Distribution (Percent) of Women and Children by Cholesterol Intakes and Reduction Needed to Meet Target Level.

TABLE 3-11

Distribution (Percent) of Women and Children by Cholesterol Intakes and Reduction Needed to Meet Target Level.

Summary

Data from the 1977-1978 NFCS indicate that about 52 percent of the survey population had mean daily cholesterol intakes above 300 mg. This group included 78 percent of males ages 19 to 64 and 52 percent of females ages 19 to 64 years (Table 3-9). Dietary cholesterol intakes from the 1985 CSFII averaged 254 mg/day for children ages 1 to 5, 304 mg/day for women ages 19 to 50, and 439 mg/day for men ages 19 to 50 (Table 3-10). Nearly 77 percent of children ages 1 to 5 and 62 percent of women ages 19 to 50 from the 1985 CSFII consumed <300 mg of cholesterol per day (Table 3-11).

Calcium

Target: Calcium intake of the Recommended Dietary Allowance (RDA) for age and sex.

Dietary Guidelines

The National Institutes of Health consensus development conference statement on osteoporosis recommended adequate nutrition that included an elemental calcium intake of 1,000 to 1,500 mg/day for postmenopausal women, as well as a program of modest weight-bearing exercise and estrogen replacement (National Institutes of Health, 1984a). The National Research Council's Committee on Dietary Allowances recommended calcium intakes of 800 mg/ day for children ages 1 to 10 and adults ages 19 and older (National Research Council, 1980). For males and females ages 11 to 18, the recommended daily intake is 1,200 mg. For infants under 6 months, the RDA is 360 mg; for children ages 6 months to 1 year, the RDA is 540 mg. During pregnancy and lactation, an increase of 400 mg/day is recommended for women. This committee accepts as the target level the RDA for calcium for the various age and sex groups.

Dietary Survey Data

Data from the 1977-1978 NFCS indicate that about 42 percent of the survey population had calcium intakes below 70 percent of the RDA, and 26 percent had intakes between 70 and 100 percent of the RDA. These data are presented in Table 3-12. Table 3-13 compares calcium intakes from the 1977-1978 NFCS and the 1985 CSFII for men, women, and children. Average intakes as well as intakes per 1,000 kcal have increased for all three of these population groups. CSFII dietary levels of calcium averaged above the RDA for men and children and were about half the RDA for adult women.

TABLE 3-12. Distribution (Percent) of Individuals by Calcium Intakes and Increases (as a percentage of RDA) Needed to Meet Target Level.

TABLE 3-12

Distribution (Percent) of Individuals by Calcium Intakes and Increases (as a percentage of RDA) Needed to Meet Target Level.

TABLE 3-13. Mean Daily Dietary Calcium Intakes for Individuals.

TABLE 3-13

Mean Daily Dietary Calcium Intakes for Individuals.

Of interest in the 1977-1978 NFCS and the 1985 CSFII data are the percentage of individuals using vitamin and mineral supplements and how this figure has changed recently (Table 3-14). The percentage of children ages 1 to 3 using supplements has increased by about 20 percent and for children ages 4 to 5, by about 35 percent, with an overall increase for children ages 1 to 5 of about 26 percent. For women ages 19 to 34, there has been a 37 percent increase and for women ages 35 to 50, a 66 percent increase, for an overall increase among women ages 19 to 50 of about 48 percent. For men ages 19 to 34, there has been a 70 percent increase, and for men ages 35 to 50, a 67 percent increase, for an overall increase among men ages 19 to 50 of about 69 percent.

TABLE 3-14. Use of Vitamin and Mineral Supplements.

Summary

Data from the 1977-1978 NFCS indicate that 42 percent of the survey population have diets containing less than 70 percent of the RDA for calcium, including more than 50 percent of females age 19 and older. Another 26 percent of the survey population have diets containing from 70 to 100 percent of the RDA for calcium, including 31 percent of adolescents ages 9 to 18 (Table 3-12). Mean calcium intakes increased from the 1977-1978 NFCS to the 1985 CSFII for men, women, and children; but women's mean intakes still fell short of the RDA (Table 3-13). About three-fourths of the women did not meet 100 percent of the RDA; of this group, half did not achieve 70 percent of the RDA.

Iron

Target: Iron intake of the RDA for age and sex.

Definition and Prevalence of Iron-Deficiency Anemia

Iron deficiency is frequently cited as the most common single nutritional deficiency in the world and the cause of the most common form of childhood anemia in the United States (Dallman et al., 1984). Nutritional iron deficiency is caused by inadequate amounts of iron in the diet and can adversely affect health status, including a reduction in maximal work capacity, altered immune response, and, in children, behavioral abnormalities and a reduction in intellectual performance (Federation of American Societies for Experimental Biology, Life Sciences Research Office, 1984).

The NHANES II (1976-1980) data on iron status were analyzed by an expert scientific working group of the Life Sciences Research Office, Federation of American Societies for Experimental Biology (1984). The group's findings on the prevalence of impaired iron status are summarized in Table 3-15. It concluded that several population segments had relatively high prevalences of impaired iron status and warranted further consideration, including children ages 1 to 2, males ages 11 to 14, and females ages 15 to 44. It also concluded that the prevalence of impaired iron status was higher for blacks than for whites, was higher for persons below the defined poverty level than for those above it, and was associated with lower education level and, for women, higher parity.

TABLE 3-15. Prevalence of Impaired Iron Status, 1976-1980.

TABLE 3-15

Prevalence of Impaired Iron Status, 1976-1980.

A recent report from the Pediatric Nu trition Surveillance System of the Centers for Disease Control (1986b) indicated a decline in the prevalence of anemia among children enrolled in public nutrition and health programs during 1975 to 1985. The prevalence of anemia dropped from 7.8 percent in 1975 to 2.9 percent in 1985, with greater declines among children examined at follow-up visits as compared to those of the same age at initial visits. Vasquez-Seoane et al. (1985) have suggested that the decline was probably related to improvements in iron nutrition during infancy and childhood, due partly to participation in public nutrition and health programs.

Data on children from public health programs with hematocrit values below the 5th percentile are presented in Table 3-16. As with other indicators of poor nutritional status, the incidence of low hematocrits differs widely among age and ethnic groups.

TABLE 3-16. Percentage of Low-Income Children Screened with Hematocrit Values Below the 5th Percentile, 31 States, United States, 1984.

TABLE 3-16

Percentage of Low-Income Children Screened with Hematocrit Values Below the 5th Percentile, 31 States, United States, 1984.

Dietary Guidelines for Iron Intake

The National Research Council's Committee on Dietary Allowances (National Research Council, 1980) recommends an iron intake of 10 mg/day for infants up to age 6 months, children ages 4 to 10, males 19 and older, and females 51 and older. It recommends an intake of 15 mg/day for children ages 6 months to 3 years, and an intake of 18 mg/day for males ages 11 to 18 and females ages 11 to 50. During pregnancy and lactation, it suggests a daily supplement of 30 to 60 mg of iron. This committee accepts as a target level the RDA for iron for the various age and sex groups.

Dietary Survey Data

The data from the 1977-1978 NFCS indicate that approximately 33 percent of the survey population had iron intakes of less than 70 percent of the RDA, 23 percent had intakes between 70 and 100 percent of the RDA, and about 44 percent had intakes that met or exceeded the RDA (U.S. De partment of Agriculture/U.S. Department of Health and Human Services, 1986). These data are summarized in Table 3-17. Groups with the lowest intakes are those previously described as having the highest prevalences of impaired iron status, including children to age 5, males ages 11 to 14, and females in their reproductive years, ages 15 to 50. The most current dietary intake data on men, women, and children are presented and compared to data from the 1977-1978 NFCS in Table 3-18. Mean intakes for all three groups have increased somewhat from 1977 to 1985. For children, intakes per 1,000 kcal have also risen, but for men and women the figure has fallen.

TABLE 3-17. Distribution (Percent) of Individuals by Iron Intakes and Increases (as a percentage of RDA) Needed to Meet Target Level.

TABLE 3-17

Distribution (Percent) of Individuals by Iron Intakes and Increases (as a percentage of RDA) Needed to Meet Target Level.

TABLE 3-18. Mean Daily Iron Intakes for Individuals.

TABLE 3-18

Mean Daily Iron Intakes for Individuals.

Summary

Data from the 1977-1978 NFCS indicate that 33 percent of the survey population have diets containing less than 70 percent of the RDA, including more than 50 percent of females ages 9 to 64. Another 23 percent of the population have diets containing only 70 to 100 percent of the RDA for iron, including 38 percent of males and 27 percent of females ages 9 to 18 (Table 3-17). Although the mean dietary intakes of iron increased from 1977-1978 to 1985 for men, women, and children, they still averaged below the RDA for women (Table 3-18). About 95 percent of the women did not meet 100 percent of the RDA; of this group, three-fourths did not achieve 70 percent of the RDA.

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What Percent of Total Calories Should Come From Fat

Source: https://www.ncbi.nlm.nih.gov/books/NBK218170/