Older adults with obesity have higher risks of some micronutrient inadequacies and lower overall dietary quality compared to peers with a healthy weight, National Health and Nutrition Examination Surveys (NHANES), 2011-2014

Public Health Nutr. 2020 Sep;23(13):2268-2279. doi: 10.1017/S1368980020000257. Epub 2020 May 29.


Objective: To evaluate total usual intakes and biomarkers of micronutrients, overall dietary quality and related health characteristics of US older adults who were overweight or obese compared with a healthy weight.

Design: Cross-sectional study.

Setting: Two 24-h dietary recalls, nutritional biomarkers and objective and subjective health characteristic data were analysed from the National Health and Nutrition Examination Survey 2011-2014. We used the National Cancer Institute method to estimate distributions of total usual intakes from foods and dietary supplements for eleven micronutrients of potential concern and the Healthy Eating Index (HEI)-2015 score.

Participants: Older adults aged ≥60 years (n 2969) were categorised by sex and body weight status, using standard BMI categories. Underweight individuals (n 47) were excluded due to small sample size.

Results: A greater percentage of obese older adults compared with their healthy-weight counterparts was at risk of inadequate Mg (both sexes), Ca, vitamin B6 and vitamin D (women only) intakes. The proportion of those with serum 25-hydroxyvitamin D < 40 nmol/l was higher in obese (12 %) than in healthy-weight older women (6 %). Mean overall HEI-2015 scores were 8·6 (men) and 7·1 (women) points lower in obese than in healthy-weight older adults. In addition, compared with healthy-weight counterparts, obese older adults were more likely to self-report fair/poor health, use ≥ 5 medications and have limitations in activities of daily living and cardio-metabolic risk factors; and obese older women were more likely to be food-insecure and have depression.

Conclusions: Our findings suggest that obesity may coexist with micronutrient inadequacy in older adults, especially among women.

Keywords: Healthy Eating Index; National Health and Nutrition Examination Survey; Nutritional biomarker; Obesity; Total usual nutrient intake.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Body Weight
  • Calcium / administration & dosage
  • Calcium / blood
  • Cross-Sectional Studies
  • Diet / methods*
  • Diet / standards
  • Dietary Supplements
  • Female
  • Humans
  • Magnesium / administration & dosage
  • Magnesium / blood
  • Male
  • Micronutrients / administration & dosage*
  • Micronutrients / blood
  • Micronutrients / deficiency
  • Middle Aged
  • Nutrition Surveys
  • Nutritional Status*
  • Obesity / blood
  • Obesity / epidemiology*
  • Overweight / blood
  • Overweight / epidemiology*
  • Risk Factors
  • United States / epidemiology
  • Vitamin B 6 / administration & dosage
  • Vitamin B 6 / blood
  • Vitamin D / administration & dosage
  • Vitamin D / blood
  • Vitamins / administration & dosage


  • Micronutrients
  • Vitamins
  • Vitamin D
  • Vitamin B 6
  • Magnesium
  • Calcium