Abstract：
Healthier dietary patterns involve more plant-based foods than current Western diets rich in animal products containing high amounts of bioavailable iron and zinc. Little consideration is given to the bioavailability of iron and zinc when studying healthy eating patterns.
Our aim was to determine whether currently estimated requirements for bioavailable iron and zinc limit the identification of healthier dietary patterns.
Using dietary data from a representative French survey and multicriteria nonlinear optimization, we identified diets that maximize health criteria based on food-based dietary guidelines and concomitantly depart only minimally from the observed diet while complying with all nutrient reference values either strictly (nonflexible optimization) or by allowing bioavailable iron and zinc below the current reference values, but to a limited extent (flexible optimization). Using a comparative risk assessment model, we estimated the resulting impact on cardiometabolic and colorectal cancer mortality/morbidity and changes to iron-deficiency anemia.
Under nonflexible optimization, reference values for bioavailable iron and zinc were the most binding of the 35 nutrient constraints, and modeled diets displayed considerable redistributions within grains and meat. With flexible optimization, modeled diets were healthier as they contained less red meat and more whole-grain products, but would increase iron-deficiency anemia to 5.0% (95% CI: 3.9%, 6.4%). Globally, in terms of disability adjusted life years (DALYs), as the loss due to anemia would represent <30% of the gain otherwise made on chronic diseases, adding flexibility in the iron and zinc reference values would result in a further 18% decrease in the disease burden from 84,768 [95% uncertainty interval (UI): 81,066, 88,470] to 99,689 (95% UI: 95,787, 103,591) DALYs averted.
Currently estimated requirements for bioavailable iron and zinc proved to be critical factors when modeling healthy eating patterns. Considering lower reference values enables the identification of diets that are apparently healthier overall.
Our aim was to determine whether currently estimated requirements for bioavailable iron and zinc limit the identification of healthier dietary patterns.
Using dietary data from a representative French survey and multicriteria nonlinear optimization, we identified diets that maximize health criteria based on food-based dietary guidelines and concomitantly depart only minimally from the observed diet while complying with all nutrient reference values either strictly (nonflexible optimization) or by allowing bioavailable iron and zinc below the current reference values, but to a limited extent (flexible optimization). Using a comparative risk assessment model, we estimated the resulting impact on cardiometabolic and colorectal cancer mortality/morbidity and changes to iron-deficiency anemia.
Under nonflexible optimization, reference values for bioavailable iron and zinc were the most binding of the 35 nutrient constraints, and modeled diets displayed considerable redistributions within grains and meat. With flexible optimization, modeled diets were healthier as they contained less red meat and more whole-grain products, but would increase iron-deficiency anemia to 5.0% (95% CI: 3.9%, 6.4%). Globally, in terms of disability adjusted life years (DALYs), as the loss due to anemia would represent <30% of the gain otherwise made on chronic diseases, adding flexibility in the iron and zinc reference values would result in a further 18% decrease in the disease burden from 84,768 [95% uncertainty interval (UI): 81,066, 88,470] to 99,689 (95% UI: 95,787, 103,591) DALYs averted.
Currently estimated requirements for bioavailable iron and zinc proved to be critical factors when modeling healthy eating patterns. Considering lower reference values enables the identification of diets that are apparently healthier overall.
摘要：
健康的饮食模式涉及更多的植物性食品比目前西方饮食富含动物产品含有大量的生物可利用的铁和锌。在研究健康饮食模式时，很少考虑铁和锌的生物利用度。
我们的目标是确定目前对生物可利用的铁和锌的估计需求是否限制了对更健康饮食模式的识别。
使用来自法国代表性调查和多标准非线性优化的饮食数据，我们根据以食物为基础的饮食指南确定了最大限度地提高健康标准的饮食，并同时仅最低限度地偏离观察到的饮食，同时严格遵守所有营养参考值（非灵活优化）或允许生物可利用的铁和锌低于当前参考值，但程度有限(灵活优化)。使用比较风险评估模型，我们估计了由此对心脏代谢和结直肠癌死亡率/发病率以及缺铁性贫血变化的影响.
在非柔性优化下，生物可利用的铁和锌的参考值是35种营养素限制中最具约束力的，模型饮食在谷物和肉类中显示出相当大的重新分配。通过灵活的优化，模型饮食更健康，因为它们含有更少的红肉和更多的全谷物产品，但会使缺铁性贫血增加到5.0％（95％CI：3.9％，6.4%）。全球范围内,就残疾调整寿命年(DALYs)而言，由于贫血导致的损失将代表<30％的收益，否则在慢性疾病，增加铁和锌参考值的灵活性将导致疾病负担进一步减少18%,从84,768[95%不确定度区间(UI):81,066,88,470]减少至99,689(95%UI:95,787,103,591)避免DALYs.
目前估计的生物可利用的铁和锌的需求被证明是建立健康饮食模式时的关键因素。考虑较低的参考值使得能够识别总体上明显更健康的饮食。
我们的目标是确定目前对生物可利用的铁和锌的估计需求是否限制了对更健康饮食模式的识别。
使用来自法国代表性调查和多标准非线性优化的饮食数据，
在非柔性优化下，
目前估计的生物可利用的铁和锌的需求被证明是建立健康饮食模式时的关键因素。
