Micronutrients — Assessment, requirements, deficiencies, and interventions

Authors: Allen, Lindsay

Submitted to: New England Journal of Medicine
Publication Type: Review Article
Publication Acceptance Date: 1/30/2025
Publication Date: 3/6/2025
Citation: Allen, L.H. 2025. Micronutrients — Assessment, requirements, deficiencies, and interventions. New England Journal of Medicine. 392(10):1006-1016. https://doi.org/10.1056/NEJMra2314150.
DOI: https://doi.org/10.1056/NEJMra2314150

Interpretive Summary: There are about 20 essential micronutrients (MNs), each of which produces different symptoms of clinical deficiency and has different effects on metabolism, protein synthesis and genes. Basic information about MNs is available in textbooks, reports on how requirements were established1, reviews, and websites so the main purpose of this article is to provide an overview of current issues in MN assessment, interventions and research that are of interest to health practitioners. In the USA the prevalence of most MN deficiencies is low but national surveys, namely the National Health and Nutrition Examination Survey (NHANES) which assesses biochemical markers of nutritional status, and What We Eat in America (WWEIA) which measures nutrient intakes, provide some data on population MN status. However, these measures are made cross-sectionally, so it is difficult to infer causality between MN status and chronic diseases and to assess the health benefits of interventions such as supplementation. In contrast, in recent decades there has been a concerted global effort to study MN deficiencies and interventions in low-middle income countries (LMICs) and population groups where the prevalence and severity of most deficiencies is higher. One third of the world’s population has one or more MN deficiencies.

Technical Abstract: There are ˜20 essential micronutrients (MNs), each of which produces different symptoms of clinical deficiency and has different effects on the metabolome, proteome and genome. Basic information about MNs is available in textbooks, reports on how requirements were established1, reviews, and websites2 so the main purpose of this article is to provide an overview of current issues in MN assessment, interventions and research that are of interest to health practitioners. In the USA the prevalence of most MN deficiencies is low but national surveys, namely the National Health and Nutrition Examination Survey (NHANES) which assesses biochemical markers of nutritional status, and What We Eat in America (WWEIA) which measures nutrient intakes, provide some data on population MN status. However, these measures are made cross-sectionally, so it is difficult to infer causality between MN status and chronic diseases and to assess the health benefits of interventions such as supplementation. In contrast, in recent decades there has been a concerted global effort to study MN deficiencies and interventions in low-middle income countries (LMICs) and population groups where the prevalence and severity of most deficiencies is higher. One third of the world’s population has one or more MN deficiencies.