Impact of Simulated Caloric Reduction on Nutrient Adequacy Among U.S. Adults with Overweight or Obesity (National Health and Nutrition Examination Survey [NHANES] 2015–2018)
Open accessAbstract
Current guidelines for the treatment of obesity recommend dietary restriction to create a caloric deficit, and caloric reductions of 16% to 68% have been achieved in adults with overweight or obesity engaging in intentional weight loss programs. This study models the impact of simulated caloric reduction on nutrient adequacy among U.S. adults ≥19 y with overweight or obesity using National Health and Nutrition Examination Survey data (2015–2018). Four levels of caloric reduction (20%, 30%, 40%, and 50%) were modeled by prorating daily calorie intake such that usual intakes of 14 nutrients were reduced proportional to caloric reduction. The percentages below the estimated average requirement (EAR) or above the adequate intake (AI) were estimated at each level of caloric reduction, with and without dietary supplement use. Differences across percentages of simulated caloric reductions were determined using nonoverlapping confidence intervals of the means (97.5th percentile confidence intervals were used to approximate P < 0.05). There were significant differences (P < 0.05) in percentages below the EAR (above the AI) between sequential levels of simulated caloric reduction for most of the nutrients analyzed (protein, vitamins A, B-6, folate, and C, calcium, iron, magnesium, potassium, and zinc). For example, after a simulated 30% caloric reduction, 25%–40% of the population had intakes below the EAR for protein, vitamin B-6, and zinc, and 75%–91% of the population had intakes below the EAR for vitamin A, calcium, and magnesium (vs. 4%–18% and 45%–56%, respectively, without caloric reduction). With the inclusion of dietary supplements, percentages below the EAR for all nutrients (except protein) were lower than those for food alone. Caloric reduction may exacerbate nutrient inadequacies among adults with overweight or obesity. Inclusion of nutrient-dense foods, fortified foods, specially formulated products, and/or dietary supplements should be considered for those on calorie-restricted diets for long-term weight loss.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Those with obesity who have engaged in some form of calorie or dietary restriction have a higher likelihood of developing nutritional deficiencies.
“Those with obesity who have engaged in some form of calorie or dietary restriction have a higher likelihood of developing nutritional deficiencies [53,98,99,130,131]”
From Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment (2025) · cites this paper as [99]
Cites
Tirzepatide Once Weekly for the Treatment of Obesity
Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C., et al. (2022) · New England Journal of Medicine · doi:10.1056/nejmoa2206038 · Cited by 3,838 · see citing works
Eisenberg, D., Shikora, S. A., Aarts, E., Aminian, A., Angrisani, L., Cohen, R. V., De Luca, M., Faria, S. L., Goodpaster, K. P. S., Haddad, A., et al. (2022) · Surgery for Obesity and Related Diseases · doi:10.1016/j.soard.2022.08.013 · Cited by 985 · see citing works
Friedrichsen, M., Breitschaft, A., Tadayon, S., Wizert, A., & Skovgaard, D. (2021) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.14280 · Cited by 427 · see citing works
Samson, S. L., Vellanki, P., Blonde, L., Christofides, E. A., Galindo, R. J., Hirsch, I. B., Isaacs, S. D., Izuora, K. E., Low Wang, C. C., Twining, C. L., et al. (2023) · Endocrine Practice · doi:10.1016/j.eprac.2023.02.001 · Cited by 375 · see citing works
Optimal Diet Strategies for Weight Loss and Weight Loss Maintenance
Kim, J. Y. (2021) · Journal of Obesity & Metabolic Syndrome · doi:10.7570/jomes20065 · Cited by 193 · see citing works
Seimon, R. V., Wild-Taylor, A. L., Keating, S. E., McClintock, S., Harper, C., Gibson, A. A., Johnson, N. A., Fernando, H. A., Markovic, T. P., Center, J. R., et al. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.13733 · Cited by 152 · see citing works
Wadden, T. A., Chao, A. M., Moore, M., Tronieri, J. S., Gilden, A., Amaro, A., Leonard, S., & Jakicic, J. M. (2023) · Current Obesity Reports · doi:10.1007/s13679-023-00534-z · Cited by 129 · see citing works
Pownall, H. J., Bray, G. A., Wagenknecht, L. E., Walkup, M. P., Heshka, S., Hubbard, V. S., Hill, J., Kahn, S. E., Nathan, D. M., Schwartz, A. V., et al. (2015) · Obesity · doi:10.1002/oby.21005 · Cited by 94 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Lifestyle Medicine for Obesity in the Era of Highly Effective Anti-Obesity Treatment
Sannidhi, D., Abeles, R., Andrew, W., Bonnet, J. P., Vitale, K., Niranjan, V., Gulati, M., Pauly, K., Moran, R., Alexander, L., et al. (2025) · Nutrients · doi:10.3390/nu17142382 · Cited by 29 · see citing works
“Counseling patients on adequate nutrition can be helpful in preventing nutrient deficiencies such as vitamins D, A, B6, folate, C, calcium, iron, magnesium, potassium, and zinc, which can be common in people with obesity and for those on hypocaloric diets [96–99].”
- Authors
- Fulgoni, V. L., Agler, A., Ricciuto, L., DiFrancesco, L., Williams, D., & Hertzler, S. R.
- Affiliations
- Abbott Nutrition (United States) (US)
- University of Toronto (CA)
- Corresponding author
- Hertzler, Steven R
- Venue
- The Journal of Nutrition
- Publisher
- Elsevier BV
- Published
- 2024-09
- Volume
- 154
- Issue
- 9
- Pages
- 2732-2742
- ISSN
- 0022-3166 (ISSN-L)
- OpenAlex
- W4400672213
- Cited by
- 8
- References
- 8
- Citations by year
- 2026: 3 · 2025: 5
- FWCI
- 3.32
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Nutrition (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Abbott Laboratories
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- caloric restriction, nutritional adequacy, overweight, obesity, weight loss, dietary supplements, nutrient intake, estimated average requirement, adequate intake, protein intake, micronutrient deficiency, calcium, magnesium, vitamin A, vitamin B6, zinc, calorie-restricted diet
- MeSH terms
- Nutrients, Adult, Energy Intake, Female, Humans, Male, Middle Aged, Nutrition Surveys, Nutritional Status, Obesity, United States, Caloric Restriction, Overweight, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
