However, there are more than 70, compounds in foods 11 bound together in a food matrix, which synergistically impact metabolism, including nutrient absorption, and may have beneficial effects on satiety and the immune system, offering protection from disease, among other potentially important health implications 12 — Thus, fortifying staple foods with priority micronutrients is important but does not fully replicate inherently nutrient-dense foods and their health effects.

Obtaining adequate micronutrients from minimally processed foods may have additional benefits beyond fortification due to the added value of diverse synergistic nutrients within a food matrix 12 — Moreover, while there is large variation in the health effects of different foods and dietary patterns, energy-dense ultra-processed foods UPFs in particular are associated with numerous non-communicable diseases NCDs and mortality UPFs make up a large share of calories in most high-income countries and are increasing rapidly in most LMICs Energy-dense ultra-processed foods are generally hyper palatable which can lead to overconsumption and weight gain when they are a predominant component of the food environment Improving overall diet quality, especially the quantity and diversity of minimally processed foods inherently dense in priority micronutrients is crucial to reduce micronutrient malnutrition while minimizing the transition to UPFs and potential associated increase in NCDs.

Our study aims to identify the top food sources of commonly lacking micronutrients, which are essential for optimal health, to support efforts to reduce micronutrient malnutrition among various populations globally, particularly in low- and middle-income countries.

This aligns with the recently proposed harmonized nutrient reference values 20 , except for iron, because EFSA values are based on the assumption that the population has iron stores, which is not the case for many people in LMICs. We used recommended nutrient intakes rather than average requirements because we are interested in target values for individuals, not in estimating population level adequacy.

We built a global food composition database excluding fortified foods , with values for calories, phytate 21 , and six priority micronutrients: vitamin A, folate, vitamin B 12 , calcium, iron, and zinc. Nutrient densities are from USDA FoodData Central FDC 22 and national and regional food composition tables FCTs from LMICs globally 23 : Kenya, Malawi, and Western Africa Sub-Saharan Africa ; Bangladesh, Indonesia, Laos, Vietnam, and ASEAN South and South-East Asia ; Mexico and Colombia Latin America.

These FCTs contained values from analyzed foods. However, for teff, fonio, and small dried fish, we also included values from the literature due to limited availability in FCTs see Supplementary Material for details. Foods were aggregated when showing relatively low nutrient density variance for example, pulses and yogurt or when likely to be targeted as a food group in policy and programming for example, DGLVs.

Global nutrient values for individual foods were obtained by calculating medians of composite values from the selected FCTs. Global nutrient values for aggregated food groups were obtained by averaging composite values at the regional level and from FDC. Composite values for a given region were obtained by calculating the medians of nutrient values for several individual foods within a food group, available in the selected FCTs corresponding to that region.

Standard deviations were calculated for all obtained global nutrient values, as a measure of variability across included FCTs. We accounted for iron and zinc bioavailability. Foods were classified into one of four levels of micronutrient density based on the calories and grams needed to provide one-third for individual nutrients or an average of one-third for the aggregate score of recommended intakes of vitamin A, folate, vitamin B 12 , calcium, iron, and zinc.

For the aggregate score, the average share of recommended intakes ASRI across the six micronutrients A , for a given quantity of calories and grams i , of a given food j , was calculated as:.

A similar approach was previously used to identify micronutrient-dense complementary foods for young children 4 , Ratings were calculated for different population groups according to the following thresholds for Average Requirements ARs of energy for a moderately active individual 18 and hypothetical ARs for mass, assuming an energy density of 1.

Micronutrient density of milk was classified based solely on ARs for energy, since mass is typically not a limiting factor for liquids. The same energy thresholds as for solid foods were used for very high and low micronutrient density. This approach ensures that for foods to rate high, they need to be high in at least two micronutrients and that foods with very high densities of individual micronutrients are not rated higher for providing amounts well above recommended intakes or above upper limits.

Recommended nutrient intakes vary by population and, for iron and zinc, bioavailability Table 1. Among groups with roughly similar ARs for energy, recommended nutrient intakes are generally highest for pregnant women, followed by adults, WRA, and adolescents, but there is variability by nutrient.

Recommended intakes for vitamin A, vitamin B 12 , calcium, and zinc vary less across these groups. Table 2 shows the compiled global food composition database of 41 individual and aggregate foods, with values for the six priority micronutrients, energy, phytate, and iron and zinc bioavailability a version of the global food composition database which includes standard deviations is available in Supplementary Table 1.

Interestingly, some food groups showed high nutrient density variance across included foods, such as DGLVs, with spinach, amaranth leaves, and cassava leaves having much higher values than lettuce and cabbage Supplementary Table 4.

Similarly, hard cheese for example, cheddar and aged goat cheese and fatty fish for example, herring and mackerel were more nutrient-dense than soft cheese for example, cottage cheese and lean fish for example, cod and tilapia , respectively Supplementary Table 6.

Other food groups, such as pulses, presented more equal nutrient density distributions across foods, but there were significant differences across FCTs Supplementary Tables 2 — 7. The quantity of calories and grams required to provide an average of one-third of recommended intakes for WRA of vitamin A, folate, vitamin B 12 , calcium, iron, and zinc varies widely by food Figure 1.

Foods with a high aggregate micronutrient density include goat milk and pork. Foods with a moderate aggregate micronutrient density include yogurt, fresh fish including different species of marine and freshwater fish , pulses, and teff.

All other foods included in the analysis scored as having low aggregate micronutrient density for WRA. Figure 1. Calories and grams needed to provide an average of one-third of recommended intakes of vitamin A, folate, vitamin B 12 , calcium, iron, and zinc for women of reproductive age.

Hypothetical average requirements for mass are based on an energy density of 1. AR, average requirement; Vit, vitamin. Most animal-source foods and DGLVs were top sources of two or more micronutrients.

All foods contained at least a moderate density of at least one of the six micronutrients except for other vegetables; roots, tubers, and plantains; nuts; and refined grain products. Figure 2. Aggregate and individual micronutrient density scores for women of reproductive age. prod, products; veg, vegetables.

Top iron sources included organs, bivalves, small dried fish, goat, and teff, each providing one-third of recommended iron intakes with less than one-sixth of ARs for energy and hypothetical ARs for mass Figures 2 , 3. Top vitamin A sources included liver including beef, goat, lamb, chicken, and pork liver , small dried fish, DGLVs, bivalves, eggs, cow milk, cheese, and vitamin A-rich fruits and vegetables.

Top calcium sources included small dried fish, DGLVs, bivalves, cow milk, canned fish with bones, cheese, goat milk, and yogurt. Top folate sources included liver, DGLVs, eggs, pulses, and quinoa. Finally, top vitamin B 12 sources included organs, small dried fish, bivalves, crustaceans, ruminant meat, eggs, milk, cheese, canned fish, pork, yogurt, and fresh fish.

Figure 3. Calories and grams needed to provide one-third of recommended iron intakes for women of reproductive age. Micronutrient density scores may vary depending on the population, given differences in recommended nutrient intakes.

The aggregate micronutrient density ratings remained similar for all other groups, with a few exceptions Figures 4 , 5 and Supplementary Figures 1 — 6.

Cheese rated very high for children 2—4 years, adolescents, WRA, and pregnant women but high for adults. Notably, vitamin A-rich fruits and vegetables and seeds rated high for children 2—4 years but low for all other groups.

Canned fish without bones rated moderate for children 2—4 years, adolescents, and adults but low for WRA and pregnant women. Quinoa rated moderate for children 2—4 years and adolescents but low for all other groups. Finally, teff rated low for pregnant women but moderate for all other groups.

Figure 4. Figure 5. Mod, moderate; prod, products; veg, vegetables. There were many differences in ratings for specific micronutrients depending on the population, especially for iron and folate Figures 5 , 6 and Supplementary Figures 4 — 6.

Organs, bivalves, small dried fish, and goat were the only foods that rated as top iron sources for all population groups. For iron, DGLVs rated low for pregnant women but high for all other groups, while crustaceans rated low for pregnant women, moderate for children 2—4 years and WRA, and high for adolescents and adults.

Beef was a top source of iron for children 2—4 years, adolescents, and adults but rated high for WRA and pregnant women. For adults, teff, fonio, sorghum, pulses, and millet were all top iron sources, whereas they all rated low for pregnant women, except for teff and fonio, which rated moderate.

Further, quinoa, canned fish with bones, eggs, seeds, and pork also rated high for iron for adults, while they rated moderate quinoa, canned fish with bones, and eggs or low seeds and pork for WRA and low for pregnant women.

In addition, several food groups presented moderate iron density for adults, including fresh fish, canned fish without bones, whole grains, and unrefined grain products, whereas they all rated low for both WRA and pregnant women. Finally, for pregnant women, the only top folate sources were liver and pulses, whereas for adults and WRA top sources also included DGLVs and quinoa, with the addition of eggs for WRA and kidney including beef, lamb, and pork kidney , fonio, and teff for children 2—4 years and adolescents.

Figure 6. Our analysis has provided ratings of inherent food sources of multiple and individual micronutrients commonly lacking in diets, especially in LMICs, for population groups with increased needs and the broader adult population. In general, animal-source foods and DGLVs are top sources of priority micronutrients.

Interestingly, many foods commonly promoted as nutrient-dense, including most fruits and vegetables, nuts and seeds, whole grains and, even animal-source foods like chicken and canned fish without bones, are not particularly dense in bioavailable micronutrients commonly lacking in LMICs.

These foods, of course, provide important nutritional benefits beyond these specific nutrients. Indeed, priority micronutrients are just one of many important aspects contributing to overall diet quality, and foods presenting low density in priority micronutrients may be rich in other essential and non-essential beneficial compounds and can contribute to overall energy and protein requirements.

These findings have implications for how to address important micronutrient gaps in the general population through food-based interventions. They are particularly relevant for populations with increased nutrient needs, such as pregnant women and WRA.

We show that pregnant women and WRA need particularly nutrient dense foods to meet requirements and our analysis helps identify foods to prioritize. Programs and policies seeking to address undernutrition through dietary interventions in the most vulnerable populations could be improved by promoting specific foods containing the highest densities in bioavailable micronutrients commonly lacking, such as organs, small dried fish, DGLVs, and bivalves.

For instance, policy makers and program managers could incentivize production of these foods to increase their availability and affordability, as well as adopt social protection policies and provide cash transfers to low-income households to purchase nutrient-dense foods.

In addition, they could establish nutrition education programs within schools and the public health system and implement social and behavior change communication campaigns through mass media, to sensitize the general population or targeted groups on the importance of regularly consuming these foods within the context of a broader healthy diet.

Similar policy and program implications have been identified in a related analysis that focused specifically on young children during the complementary feeding period in South and Southeast Asia and which found that organs, eggs, and bivalves had the highest densities of bioavailable micronutrients commonly lacking These findings also have important implications for vegetarian populations, since animal flesh foods are dense in priority micronutrients.

In addition to DGLVs, both eggs and dairy foods are excellent sources of priority micronutrients for lacto-ovo vegetarians. Fortunately, eggs and dairy foods are among the more affordable animal-source foods per unit priority nutrient density, although not as affordable as organs and small fish, and they are still often inaccessible or unaffordable for people with limited resources 32 , Importantly, DGLVs and pulses are accessible and affordable sources of several priority micronutrients in most populations 32 , Further, traditional grains, including teff, quinoa, fonio, and millet, are at least moderately dense in iron, zinc, and folate and can also make significant contributions to nutrient adequacy.

Lacto-ovo vegetarian diets rich in eggs, dairy, DGLVs, pulses, and traditional grains can provide adequate amounts of all six priority micronutrients. Carefully constructed vegan diets could provide adequate amounts of all six priority micronutrients for the general population, except vitamin B 12 , which would need to be consumed through fortified foods or supplements.

However, population groups with increased nutritional requirements, such as pregnant women and children during the complementary feeding period, following a vegan diet likely also need fortification or supplementation for other micronutrients, such as iron, in addition to vitamin B Importantly, to the extent possible, the pursuit of dietary nutrient adequacy for the global population should not come at the expense of increased environmental destruction.

There may be some inevitable trade-offs between achieving micronutrient adequacy and minimizing the environmental impact of diets, but there is great potential to improve the sustainability of all types of foods using productive regenerative practices suitable to local ecosystems 36 — Particular attention could be given to nutrient dense foods with the greatest potential for sustainable production.

For example, seaweeds, bivalves, and small fish are generally highly nutrient dense and sustainable to produce While there may be nutritional advantages of obtaining nutrients through foods 12 — 14 , the very high iron requirements of more than 1. Finally, plant-source foods generally have lower negative environmental impact than animal-source foods per unit protein, energy, or mass based on current production practices and existing metrics used to quantify environmental impact However, this generalization may not hold when considering the higher bioavailable nutrient density of many animal-source foods as shown in the present analysis and others 34 , 36 , or when considering regenerative production practices and metrics that holistically quantify their environmental impacts 37 , 38 , Our study has several strengths.

The methods are transparent and based on publicly available data, as has been recommended 42 , The food composition data is comprehensive and representative of diets in diverse contexts globally, unlike existing nutrient profiling systems, which are based solely on national food composition data, typically USDA FDC 42 , 43 , and we adjusted for differences in bioavailability of iron and zinc across foods.

Similarly, recommended intakes are based on dietary reference values that are appropriate for global populations, including LMICs, and were calculated for the general adult population as well as groups with increased needs. Our ratings prioritize foods that are optimal sources of micronutrients known to be commonly lacking and causing significant health burdens in LMICs, in alignment with the recommendation to focus nutrient profiling models for LMICs on nutrient density of beneficial nutrients, rather than nutrients to limit Lastly, the results are organized in clear and simple visualizations which are easily interpretable by non-technical audiences, including decision makers.

We focused on inherent priority micronutrient density and bioavailability and did not include fortified foods or address the overall role of food and diets in nutrient adequacy, infectious diseases, and NCDs and their broader impact on the global burden of disease Other essential vitamins and minerals, including vitamin C, vitamin E, riboflavin, thiamin, niacin, potassium, and magnesium, can also be lacking in diets, but data is limited on how widespread these inadequacies are and their public health significance 1.

Moreover, adequate calories 45 , protein 46 , and essential amino acids 47 and fatty acids especially n-3 fatty acids 48 are also often lacking and critically important for health. Finally, there are numerous compounds that are associated with increased risk of disease when consumed in excess, including sugar, sodium, trans fat, cosmetic additives, and contamination and biological hazards in unsafe food, among others, for which the type and level of processing often plays an important role 49 — Our analysis has important limitations.

Moreover, mineral densities have even been shown to vary geospatially within individual countries Since the exact nutrient densities of any given food and context are unknown, we chose to use aggregate values to smooth out these variations, which contributes to the added value of our global food composition database.

Second, in addition to significant differences across FCTs, there is sometimes high nutrient-density variance across foods within food groups, meaning that the ranking of a food group as a whole might not reflect the micronutrient density of the most or least nutrient-dense foods included.

However, we chose to maintain these levels of aggregation because our selected food groups are more likely to be targeted in programming and policies than individual foods and match more closely with food groups in upcoming global diet quality monitoring data 53 , Third, country and regional FCTs only included a limited set of commonly consumed foods, which limited the breadth of foods included in our aggregated food composition database.

For instance, we were unable to analyze many nutrient-dense wild or indigenous vegetables, nuts, seeds, pulses, and insects, or novel foods like ground eggshells. Fourth, while we adjusted for bioavailability of iron and zinc, actual bioavailability depends on the genetics and micronutrient status of the individual and their overall diet, including a broad set of enhancers and inhibitors.

Finally, ratings are sensitive to categorical thresholds for quantities of calories and grams, which requires some attention when interpreting results, since foods near the thresholds could have been rated differently with only small changes in nutrient densities.

Some of the differences in ratings across population groups could thus be due to small differences in nutrient densities for foods near thresholds. These ratings are most applicable for populations in LMICs suffering from widespread micronutrient deficiencies.

However, for population groups with increased needs in HICs, such as pregnant women and WRA, who may often be deficient in micronutrients such as iron, zinc, and folate, these results can also help identify relevant foods to prioritize.

Importantly, diets should consist of a variety of foods with varying nutrient densities. Even adding just small amounts of particularly nutrient dense animal-source foods for example, organs, small fish, and bivalves to largely plant-based diets would go a long way toward ensuring adequacy of micronutrients commonly lacking.

Future analyses should focus on understanding how to use these findings to improve food, agriculture, and nutrition policies and programs, which tend to focus on specific foods or food groups.

Researchers could build on this work by incorporating additional foods and food groups, including eggshells 55 and wild or indigenous vegetables, nuts, seeds, pulses, and insects 56 , many of which contain very high nutrient densities Moreover, these ratings could be paired with broader diet quality metrics 54 and included as an additional way to assess food affordability, for example, by expanding on existing approaches 32 , 35 , as has been done for other nutrient profiling systems Finally, these ratings could also be used to provide more nutritionally relevant indicators of the environmental impact of foods, for example, by quantifying impact in terms of nutrient density.

TB and FO designed the study, conducted the analyses, and wrote the manuscript. Both authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.

Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. We thank Lynnette M. Neufeld, Saul S. Morris, Stella Nordhagen, Gina L.

Kennedy, and Christina Nyhus Dhillon for their feedback on draft versions of the manuscript. ARs, average requirements; DGLVs, dark green leafy vegetables; EFSA, European Food Safety Authority; FCTs, food composition tables; FDC, FoodData Central; HICs, high-income countries; LMICs, low- and middle-income countries; NCDs, non-communicable diseases; UPFs, ultra-processed foods; WRA, women of reproductive age.

Beal T, Massiot E, Arsenault JE, Smith MR, Hijmans RJ. Global trends in dietary micronutrient supplies and estimated prevalence of inadequate intakes. PLoS One. doi: PubMed Abstract CrossRef Full Text Google Scholar.

Bailey RL, West KP, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. Vitamin and Mineral Nutrition Information System VMNIS. Google Scholar. Beal T, White JM, Arsenault JE, Okronipa H, Hinnouho G-M, Torlesse H, et al. Micronutrient gaps during the complementary feeding period in South Asia: a comprehensive nutrient gap assessment.

Nutr Rev. White JM, Beal T, Chimanya K, Arsenault JE, Okronipa H, Hinnouho G-M, et al. Micronutrient gaps during the complementary feeding period in Eastern and Southern Africa: a comprehensive nutrient gap assessment.

Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries.

CrossRef Full Text Google Scholar. Sethi V, Lahiri A, Bhanot A, Kumar A, Chopra M, Mishra R. Adolescents, Diets and Nutrition: Growing Well in a Changing World. New Delhi: UNICEF India Miller EM. Iron status and reproduction in US women: national health and nutrition examination survey, Smith MR, Myers SS.

Impact of anthropogenic CO2 emissions on global human nutrition. Nat Clim Change. Osendarp SJM, Martinez H, Garrett GS, Neufeld LM, De-Regil LM, Vossenaar M, et al. To maintain your brain, muscle, bone, nerves, skin, blood circulation, and immune system, your body requires a steady supply of many different raw materials—both macronutrients and micronutrients.

You need large amounts of macronutrients—proteins, fats, and carbohydrates. And while you only need a small number of micronutrients—vitamins and minerals—failing to get even those small quantities virtually guarantees disease. Nearly 30 vitamins and minerals that your body cannot manufacture in sufficient amounts on its own are called "essential micronutrients.

Even today in many low-income countries, people frequently suffer from a variety of nutrient-deficiency diseases. True vitamin and mineral deficiencies—in which the lack of a single nutrient leads directly to a specific ailment—are rare in the United States because our extensive supply of inexpensive food, and the fortification of many common foods with some key nutrients.

However, eating less than optimal amounts of important vitamins, minerals, and other compounds can still contribute to a number of major illnesses, such as heart disease, type 2 diabetes, cancer, and osteoporosis.

Hence, concern about "insufficiency"—a controversial topic—is a major driver of both the U. dietary guidelines and the mass marketing of over-the-counter supplements. So how can you make sure you're fulfilling your nutrient needs? Unfortunately, a welter of conflicting studies has led to general confusion—and all too many studies lead to new marketing claims that may or may not be upheld by later research.

In fact, the best way to get vitamins and minerals is from a well-rounded diet, with plenty of fruits, vegetables, legumes, whole grains, and lean sources of protein, along with healthy fats, such as nuts and olive oil. Howard D. Sesso, associate professor of medicine at Harvard Medical School and Medical Editor of the Special Health Report Making Sense of Vitamins and Minerals: Choosing the foods and nutrients you need to stay healthy.

Five micronutrients—vitamin B 6, vitamin C, vitamin E, magnesium, and zinc—play roles in maintaining immune function, and supplements containing them are often sold as immune boosters in doses that greatly exceed the recommended daily allowance.

However, there is no evidence that such supplements have more benefits than merely following a healthy diet. Rather than popping pills to get these micronutrients, you're wiser to use various foods to boost your immune system.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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