Trends in Nutritional Status Evaluated by Nutritional Biomarkers Among US Adults

Background: Understanding trend in nutritional status is crucial to inform national health priorities to improve diets and reduce related diseases. However, limited data was available on the trend of nutritional status estimated by nutritional biomarkers. Methods: Trends in nutritional status evaluated by health nutritional biomarkers index (HNBI) score calculated based on nutritional biomarkers were analyzed among US adults in the National Health and Nutrition Examination Surveys (NHANES, 2003-2014). The lower the HNBI score, the healthier nutritional status would be. Findings: From 2003 to 2014, the estimated overall HNBI score decreased from 4.16 to 3.61 (P-linear trend < 0.001). The HNBI scores of vitamins and lipids decreased from 0.43 to 0.34 (P-linear trend = 0.012), and 2.17 to 1.78 (P-linear trend <0.001), respectively; while the HNBI score of proteins increased from 0.09 to 0.17 (P-linear trend < 0.001). No significant trend was found for the HNBI score of minerals (P-linear trend = 0.168). Participants aged 40-59 years, men, non-Hispanic blacks, and participants with low socioeconomic status accounted for the largest overall HNBI score compared to their comparts. Vitamin B6 and vitamin D, lead, cadmium, mercury, potassium, iodine, low-density-lipoprotein cholesterol, high-density-lipoprotein cholesterol, triglyceride, and total cholesterol were the main nutrients for these specific adults to be improved. Interpretation: The overall nutritional status was improved among US adults from 2003 to 2014 but some specific populations should be paid much attention to improve their nutritional status, including adults aged 40-59 years, men, non-Hispanic blacks, and participants with low socioeconomic status. Funding Statement: National Natural Science Foundation of China (Grant Numbers: 82073536 and 81573134). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: All respondents provided written informed consent. The NHANES protocols were approved by the National Center for Health Statistics (NCHS) Research Ethics Review Board.