AUTHOR=Ghosh Santu , Kurpad Anura V. , Sachdev Harshpal S. , Thomas Tinku 

TITLE=A risk-based approach to measuring population micronutrient status from blood biomarker concentrations

JOURNAL=Frontiers in Nutrition

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2022.991707

DOI=10.3389/fnut.2022.991707

ISSN=2296-861X

ABSTRACT=Background
Nutrient biomarkers and their definitive cut-offs are used to classify individuals as nutrient-deficient or sufficient. This determinism does not consider any uncertainty, and a probability approach, using biomarker distributions, is then preferable to define the risk of nutrition deficiency when in populations.
Method
Healthy 1–19-year-old children and adolescents were selected from the Comprehensive National Nutrition Survey (CNNS), to obtain probability distributions of their retinol, zinc and vitamin B12, along with erythrocyte folate. Model-based estimates of location, scale and shape parameters of these distributions were obtained across ages. Subsequently, in the entire sample of 1-19 year old children of CNNS, the population risk of deficiency (PRD) which is average risk of deficiency in individuals in the population was computed, which is ‘of concern’ when >50%. When individual risk of deficiency is >97.5% it is called ‘severe risk of deficiency’ (SRD).
Results
In the entire CNNS sample, the PRD of concern was low for serum retinol (3.6 to 8.2%), zinc (0 to 5.5%), vitamin B12 (2.3 to 7.2%) and erythrocyte folate (4.2 to 9.7%) across age and sex groups. 
Conclusion
This proposed method assesses the adequacy of nutrient exposures without relying on pre-defined deterministic biomarker cut-offs to define micronutrient deficiency and avoids errors in exposure assessment.