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Title: Vegetables and mixed dishes are top contributors to phylloquinone intake in US adults: data from the 2011-2012 NHANES

Author
item HARSHMAN, STEPHANIE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item FINNAN, EMILY - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item BARGER, KATHRYN - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item BAILEY, REGAN - Purdue University
item Haytowitz, David
item GILHOOLY, CHERYL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item BOOTH, SARAH - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/20/2017
Publication Date: 5/31/2017
Citation: Harshman, S.G., Finnan, E., Barger, K., Bailey, R.L., Haytowitz, D.B., Gilhooly, C., Booth, S.L. 2017. Vegetables and mixed dishes are top contributors to phylloquinone intake in US adults: data from the 2011-2012 NHANES. Journal of Nutrition. 147(7):1308-1313. https://doi.org/10.3945/jn.117.248179.
DOI: https://doi.org/10.3945/jn.117.248179

Interpretive Summary: Phylloquinone is the most abundant form of vitamin K in U.S. diets. Green vegetables are rich sources of phylloquinone and are considered the predominant dietary source for phylloquinone. As our food supply diversifies and expands, the food groups that contribute to phylloquinone intake are also changing, which may change absolute intakes. Vegetable oils are moderate-to-high phylloquinone sources. Oils used in mixed dishes may then be prevalent sources of phylloquinone in the U.S. diet. Thus, it is important to identify the contributors to dietary vitamin K estimates to guide recommendations on intakes and food sources. The purpose of this study was to estimate: (1) the amount of phylloquinone consumed in the diet of U.S. adults; (2) the contribution of different food groups to phylloquinone intake in individuals with high or low vegetable intake (equal to or greater than 2 cups, less than 2 cups vegetables/day); and (3) to characterize the contribution of different mixed dishes to phylloquinone intake. Usual phylloquinone intake was determined from using data from 2,092 men and 2,214 women, aged 20 years and older, who participated in the NHANES 2011-2012 study. On average, 43% of men and 63% of women met the current adequate intakes established for phylloquinone. There were noted declines in average phylloquinone intakes among men compared to estimated intakes in 1998-2004, especially in the older age groups. Vegetables were the highest contributor to phylloquinone intake whereas mixed dishes were the second highest contributor to phylloquinone intake, particularly among individuals who consume low intakes of vegetables. In conclusion, mixed dishes are an unrecognized, but significant contributor to phylloquinone intake in the United States. Despite this, self-reported phylloquinone intakes appear to be declining among men but increasing among women over the last two decades. Additional research is required to further quantitate other vitamin K forms in the U.S. food supply and to identify all dietary sources of vitamin K to better define current recommendations.

Technical Abstract: Background: Phylloquinone is the most abundant form of vitamin K in US diets. Green vegetables are considered the predominant dietary source of phylloquinone. As our food supply diversifies and expands, the food groups that contribute to phylloquinone intake are also changing, which may change absolute intakes. Thus, it is important to identify the contributors to dietary vitamin K estimates to guide recommendations on intakes and food sources. Objective: The purpose of this study was to estimate 1) the amount of phylloquinone consumed in the diet of US adults, 2) to estimate the contribution of different food groups to phylloquinone intake in individuals with a high or low vegetable intake (>/=2 or <2 cups vegetables/d), and 3) to characterize the contribution of different mixed dishes to phylloquinone intake. Methods: Usual phylloquinone intake was determined from NHANES 2011-2012 (>/=20 y old; 2092 men and 2214 women) and the National Cancer Institute Method by utilizing a complex, stratified, multistage probability-cluster sampling design. Results: On average, 43.0% of men and 62.5% of women met the adequate intake (120 and 90 mg/d, respectively) for phylloquinone, with the lowest self-reported intakes noted among men, especially in the older age groups (51-70 and >/= 71 y). Vegetables were the highest contributor to phylloquinone intake, contributing 60.0% in the high-vegetable-intake group and 36.1% in the low-vegetable-intake group. Mixed dishes were the second-highest contributor to phylloquinone intake, contributing 16.0% in the high-vegetable-intake group and 28.0% in the low-vegetable-intake group. Conclusion: Self-reported phylloquinone intakes from updated food composition data applied to NHANES 2011-2012 reveal that fewer men than women are meeting the current adequate intake. Application of current food composition data confirms that vegetables continue to be the primary dietary source of phylloquinone in the US diet. However, mixed dishes and convenience foods have emerged as previously unrecognized but important contributors to phylloquinone intake in the United States, which challenges the assumption that phylloquinone intake is a marker of a healthy diet. These findings emphasize the need for the expansion of food composition databases that consider how mixed dishes are compiled and defined.