Lower intakes of key nutrients are associated with more school and workplace absenteeism in US children and adults: a cross-sectional study of NHANES 2003-2008

Authors: YE, QIAN - Pharmavite, Llc; DEVARSHI, PRASAD - Pharmavite, Llc; GRANT, RYAN - Pharmavite, Llc; Higgins, Kelly; MITMESSER, SUSAN - Pharmavite, Llc

Submitted to: Nutrients
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/5/2023
Publication Date: 10/13/2023
Citation: Ye, Q., Devarshi, P.D., Grant, R.W., Higgins, K.A., Mitmesser, S.H. 2023. Lower intakes of key nutrients are associated with more school and workplace absenteeism in US children and adults: a cross-sectional study of NHANES 2003-2008. Nutrients. 15(20):4356. https://doi.org/10.3390/nu15204356.
DOI: https://doi.org/10.3390/nu15204356

Interpretive Summary: Absenteeism from school and work can have long term negative consequences. School absenteeism in children can lead to more school absences in later years, reduced academic achievement, and poor socioemotional outcomes. Workplace absenteeism in adults can result in productivity loss leading to substantial costs to employers. While the literature supports the importance of nutrition in physical health, the role of nutritional status on school and work absenteeism in children and adults in the US is largely unknown. Therefore, the objective of this study was to determine whether nutritional status and nutrient intake were associated with absenteeism from school and work due to illness or injury. Data from National Health and Nutrition Examination Survey 2003-2008 were used to assess nutrient intake from food and food + supplements, nutritional biomarker levels, and school and work absenteeism per year in children (ages 6 to 18 years) and adults (ages 19 to 64 years). Children and adults who reported more absent days had significantly lower intake of protein and several micronutrients from the diet. When nutrients from supplements were included, this negative association was no longer observed for intake of vitamin B6, folate, vitamin B12, iron, and zinc for children, and vitamin B6, folate, thiamin, niacin, vitamin C and vitamin E for adults. A higher incidence of absenteeism was observed in female children with depleted iron stores compared to females with normal ferritin levels. Compared with children in the highest tertile, more absent days were observed in children in the lowest tertile of serum total folate and B12. Compared with adults with normal levels, higher incidence of absenteeism were observed in adults who were deficient or potentially deficient in vitamin B12. The negative association between nutrient status and absenteeism may be corrected by improving dietary habits, which may include access to healthier food options, more fortified food, and dietary supplements. Future studies are needed to ascertain whether more nutrient intakes, particularly for nutrients not commonly found in the typical diet or supplements, is an effective intervention to reduce absenteeism.

Technical Abstract: The influence of individual macro- and micronutrients on absenteeism in the United States is largely unknown. The objective of this study was to determine whether nutritional status or nutrient intake were associated with absenteeism from school and work due to illness or injury. Data from NHANES 2003–2008 were used to assess nutrient intake from food and food plus supplements, nutritional biomarker levels, and school and work absenteeism per year in children and adults. Negative binomial regression models were used to predict mean days of missed work per year and to estimate incidence rate ratios (IRRs) of absenteeism by nutrient biomarker status. Of 7429 children, 77% reported missing school days (mean 4.0 days). Of 8252 adults, 51% reported missing work days (mean 4.9 days). Children and adults who reported more absent days had a significantly lower intake of protein and several essential micronutrients from the diet. When nutrients from supplements were included, this negative association was retained for protein, selenium, choline, and DHA in children and for protein, selenium, vitamin K, choline, potassium, fiber, octadecatrienoic acid, and lycopene in adults. Future studies are needed to ascertain whether dietary interventions, such as access to healthier food options and/or dietary supplements, can reduce absenteeism.