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Dietary Macronutrient and Micronutrient Adequacy and Nutritional Recommendations Compliance in Young Adults: The NutAF Study

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04 May 2026

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05 May 2026

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Abstract
Background: Adequate nutrition during young adulthood is essential for health promotion, optimal physiological function, and the prevention of non-communicable diseases. However, evidence describing both nutrient adequacy and compliance with dietary recommendations in well-characterized samples of young adults remains limited. Therefore, the aim of the present study was to describe macronutrient and micronutrient adequacy and to quantify compliance with current dietary recommendations in young adults, and to analyses sex differences to identify priority targets to inform tailored health promotion and public health nutrition strategies. Methods: This cross-sectional study included 74 young adults aged 18–45 years participating in the NutAF project. Dietary intake was assessed using a 5-day dietary record, including three weekdays and two weekend days (Analysis was conducted using DIAL software). Nutrient adequacy ratios were calculated for macronutrients and micronutrients. The prevalence of compliance with current dietary recommendations was also determined. Differences between men and women were analyzed using independent samples t-tests (SPSS software was used). Results: Protein and total lipid adequacy exceeded recommended values in most participants, whereas carbohydrate and dietary fiber adequacy were below recommendations. Regarding micronutrients, adequate intake was observed for several nutrients; however, low adequacy and low compliance rates were identified for calcium, folate, iodine, and vitamin D. Fewer than 10% of participants met the recommendations for vitamin D. No significant sex differences were observed for most nutrients. Conclusions: Despite adequate intake of some macronutrients, young adults exhibited inadequate intake and low compliance with current dietary recommendations for several key nutrients. No relevant sex differences were observed for most nutrients. These findings underscore the need for targeted nutritional strategies, including nutrition education and micronutrient-focused interventions, aimed at improving dietary adequacy and supporting health promotion in this population.
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1. Introduction

Adequate nutrition plays a fundamental role in health promotion and disease prevention across the lifespan, contributing to the maintenance of metabolic health and the prevention of non-communicable diseases [1,2,3]. In fact, young adulthood represents a critical life stage during which dietary habits and lifestyle behaviors are consolidated and may persist into later life, influencing long-term cardiometabolic risk, body composition, and overall health status [4,5,6,7].
Adequate intake of both macronutrients and micronutrients is essential to support physiological function, energy metabolism, and musculoskeletal health [8,9]. However, several population-based studies have reported suboptimal dietary patterns in young adults, particularly regarding fiber, calcium, and vitamin D intake [10,11,12]. Inadequate intake of these nutrients has been associated with adverse health outcomes, including impaired bone health, increased cardiometabolic risk, and reduced effectiveness of lifestyle-based health promotion strategies [10,12,13].
Moreover, dietary imbalances during young adulthood often coexist with insufficient physical activity levels or irregular eating behaviors, further exacerbating potential health risks [14,15,16]. Some studies have highlighted the interaction between nutrition and physical activity, emphasizing the need for integrated lifestyle assessments in health promotion research [17,18].
Nutrient adequacy can be evaluated using nutrient adequacy ratios (NAR), which quantify individual nutrient intake relative to established dietary recommendations and allow for the identification of specific nutritional inadequacies [19,20]. In parallel, assessing compliance with dietary guidelines provides insight into population-level dietary patterns and identifies nutrients of public health concern [19,21].
Despite the growing body of research on dietary patterns and health outcomes, data describing both nutrient adequacy and compliance with dietary recommendations in well-characterized samples of young adults remain limited, particularly within cohorts that integrate nutritional assessment as part of a broader lifestyle and physical activity framework [22,23]. Therefore, the aim of the present study was to describe macronutrient and micronutrient adequacy and to quantify compliance with current dietary recommendations in young adults, and to analyze sex differences to identify priority targets to inform tailored health promotion and public health nutrition strategies.

2. Materials and Methods

2.1. Study Design and Participants

This cross-sectional study was conducted within the framework of the NutAF project [24,25,26,27,28,29,30,31,32,33]. A total of 74 young adults aged between 18 and 45 years were included in the analysis. Participants were recruited on a voluntary basis and met the following inclusion criteria: absence of diagnosed chronic disease and not following any specific dietary or pharmacological treatment that could affect nutritional intake. Exclusion criteria included incomplete dietary records and implausible energy intake values.
All participants were informed about the study procedures and provided written informed consent prior to participation. The study protocol was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Hospital Universitario Puerta del Mar (Cádiz, Spain).

2.2. Anthropometric and Energy Expenditure Assessment

Body mass and height were measured using a stadiometer (SECA 225; Vogel & Halke, Hamburg, Germany; precision: ±1 mm) and a Tanita bioimpedance MC-780MA multifrequency 8-electrode model (Tanita Corp, Tokyo, Japan), with participants wearing light clothing and no shoes. Body mass index (BMI) was calculated as weight (kg)/height² (m²).
Resting metabolic rate was estimated using validated predictive equations [34], and total daily energy expenditure was calculated by applying an appropriate physical activity factor. Energy balance was calculated as the difference between daily energy intake and total daily energy expenditure.

2.3. Dietary Assessment

Dietary intake was assessed using a 5-day dietary record, including three weekdays and two weekend days [35]. Participants received detailed instructions on how to record all foods and beverages consumed, including portion sizes, preparation methods, and brand names when applicable. Dietary records were reviewed with the participants to ensure completeness and accuracy prior to analysis.
Dietary data were analyzed using specialized nutritional analysis DIAL software (version 3.15; Alce Ingeniería, Madrid, Spain) to estimate daily energy intake, macronutrient intake, and micronutrient intake. Nutrient intake values were averaged across the recorded days and used for subsequent analyses.

2.4. Nutrient Adequacy Assessment

Nutrient adequacy was evaluated using NAR, calculated as the ratio between individual nutrient intake and the corresponding recommended intake for each nutrient and expressed as a percentage [36].
For prevalence analyses, compliance with dietary recommendations was defined as achieving at least 100% of the recommended intake for each nutrient based on European Food Safety Authority (EFSA). The proportion and number of participants meeting the recommendations and the number of individuals achieving compliance were calculated for macronutrients and micronutrients.

2.5. Statistical Analysis

Descriptive statistics are presented as mean ± standard deviation for continuous variables and as proportions for categorical variables. Normality of data distribution was assessed using the Shapiro–Wilk test.
Differences between men and women were analyzed using independent samples t-tests. Effect sizes were calculated using Cohen’s d and interpreted according to conventional thresholds. Statistical significance was set at p < 0.05.
All statistical analyses were performed using IBM SPSS Statistics (version 25.0; IBM Corp., Armonk, NY, USA).

3. Results

The results describe the general characteristics of the study participants, macronutrient and micronutrient adequacy, and the proportion of compliance with current dietary recommendations in the NutAF study participants.
Table 1 presents the general characteristics and energy expenditure variables of the study participants stratified by sex. Significant differences between men and women were observed for height, total daily energy expenditure, and resting metabolic rate (p < 0.001), with higher values in men. No significant differences were found for age, BMI, or energy balance.
Table 2 shows macronutrient-NAR for the total sample stratified by sex. Protein and total lipid adequacy exceeded recommended values, whereas carbohydrate and fiber adequacy were below recommended levels. No statistically significant differences were observed between men and women for macronutrient adequacy.
Micronutrient NAR are presented in Table 3. Adequacy values above recommended levels were observed for most minerals and several vitamins. Lower adequacy values were observed for vitamin D and folate. No statistically significant differences between men and women were found for most micronutrients.
Overall, no statistically significant sex differences were observed for most macronutrient and micronutrient adequacy ratios. Effect size analyses also indicated small and negligible differences between men and women for the majority of nutrients. These findings suggest a relatively homogeneous pattern of dietary adequacy across sexes in this cohort of young adults.
Table 4 and Table 5 present the proportions of compliance with dietary recommendations for macronutrients and micronutrients, respectively. High compliance rates were observed for total lipid intake and several B-group vitamins, whereas low compliance was found for carbohydrates, fiber, calcium, folate, iodine, and vitamin D.

4. Discussion

4.1. Summary of Main Findings

The present study aimed to describe macronutrient and micronutrient adequacy and to determine the prevalence of compliance with current dietary recommendations in young adults. The main findings indicate that, although protein and total lipid adequacy exceeded recommended values, inadequate intake was observed for several key nutrients, particularly carbohydrates, dietary fiber, calcium, folate, iodine, and vitamin D. Furthermore, the prevalence analyses revealed that only a small proportion of participants met the recommendations for these nutrients, highlighting relevant nutritional gaps in this population.
In the present study, no significant sex differences were observed for most macronutrient and micronutrient adequacy measures. This finding suggests that dietary inadequacies in young adulthood may be broadly shared across sexes, rather than being sex-specific in this population.
These findings, derived from both nutrient adequacy ratios and prevalence of compliance analyses, provide a comprehensive overview of dietary adequacy in young adults and identify priority nutrients of public health concern that may compromise long-term health if not addressed.

4.2. Macronutrient Adequacy and Compliance

In the present study, protein intake showed adequate or above-recommended levels in most participants, which is consistent with previous research in young adult populations and physically active cohorts. Several population-based studies have reported protein intakes exceeding current dietary recommendations in young adults, reflecting dietary patterns characterized by a high contribution of protein-rich foods [36,37].
In contrast, carbohydrate and dietary fiber adequacy were below recommended levels, with low compliance observed for both nutrients. These findings are in line with previous studies reporting insufficient carbohydrate and fiber intake among young adults, despite their central role in energy metabolism, gastrointestinal health, and cardiometabolic risk reduction [3,38,39].
Total lipid intake exceeded recommended values in most participants, with high compliance observed. However, analysis of lipid subtypes revealed imbalances in polyunsaturated fatty acid intake, particularly for omega-3 fatty acids, which showed very low compliance. This pattern has been previously described in young adult populations and may reflect dietary patterns characterized by low consumption of fatty fish and other omega-3-rich foods [10,40].

4.3. Micronutrient Adequacy and Compliance

Regarding micronutrients, adequate intake was observed for several minerals and B-group vitamins in the study population. However, low adequacy and compliance were identified for vitamin D, folate, calcium, iodine, and potassium, highlighting these nutrients as major concerns in young adults. Among them, vitamin D showed the lowest compliance, with fewer than 10% of participants meeting the recommended intake, in line with the very low adequacy values observed.
Vitamin D inadequacy has been consistently reported across European populations and is considered a widespread public health issue [41]. Low vitamin D intake in young adulthood may have implications for bone health, immune function, and long-term cardiometabolic risk [10,42].
Similarly, insufficient intake of calcium and folate was observed in a substantial proportion of participants. Low calcium intake has been associated with impaired bone mineralization and suboptimal peak bone mass acquisition, whereas inadequate folate intake has been linked to altered metabolic function and increased cardiometabolic risk. Comparable micronutrient inadequacies have been reported in population-based studies of young adults, reinforcing the need for targeted nutritional to improve micronutrient intake during this critical life stage, particularly within integrated lifestyle approaches [10,42,43,44].

4.4. Implications for Health Promotion in Young Adults

Young adulthood represents a critical period for the establishment of long-term dietary habits and lifestyle behaviors. The identification of multiple nutrient inadequacies in this population underscores the importance of early preventive strategies focused on nutrition education and lifestyle modification [45,46].
Integrating dietary assessment within broader health promotion programs that also address physical activity and other lifestyle factors may enhance the effectiveness of interventions aimed at improving overall health profiles in young adults [47]. This integrated approach aligns with current public health frameworks that emphasize the combined influence of multiple lifestyle behaviors on long-term health outcomes [47,48].
The present findings support the need for public health initiatives that promote balanced dietary patterns rich in complex carbohydrates, dietary fiber, calcium, vitamin D, and essential fatty acids. Such strategies may contribute to reducing the risk of non-communicable diseases later in life [1,49].

4.5. Strengths and Limitations

The main strengths of this study include the comprehensive assessment of both nutrient adequacy and compliance with dietary recommendations, as well as the use of detailed dietary records covering both weekdays and weekend days. Additionally, the integration of nutritional assessment within a broader lifestyle research framework allowed for the characterization of a well-defined sample of young adults.
However, several limitations should be acknowledged. The cross-sectional design precludes causal inferences, and dietary intake was self-reported, which may be subject to recall bias and under- or over-reporting. Moreover, the relatively small sample size, although comparable to those used in detailed dietary assessment studies, may limit the generalizability of the findings to other young adult populations. Despite these limitations, the present study provides valuable descriptive data on nutrient adequacy and compliance with dietary recommendations in young adults, contributing to the understanding of dietary patterns relevant for health promotion strategies.

5. Conclusions

In conclusion, the present study shows that, despite adequate protein and total lipid intake, young adults exhibit inadequate intake and low compliance with current dietary recommendations for several key nutrients, including dietary fiber, calcium, folate, iodine, and vitamin D. No relevant sex differences were identified for most nutrients, suggesting that dietary inadequacies are similarly distributed across men and women. Therefore, population-wide nutritional strategies may be appropriate to address these gaps in young adults.
These findings highlight the presence of relevant nutritional gaps during young adulthood and underscore the need for targeted nutritional strategies aimed at improving overall dietary quality and supporting long-term health promotion in this population.

Author Contributions

Conceptualization, D.V.-D., P.S.-A. and J.G.P.-G.; data curation, J.C.-P., D.V.-D., A.P.-B., M.R.-R., A.M.-G., A.M.-d.-O.-G., A.G.-M. and J.G.P.-G.; formal analysis, D.V.-D., P.S.-A. and C.C.; funding acquisition, D.V.-D. and J.G.P.-G.; resources, J.G.P.-G.; writing original draft, D.V.-D., P.S.-A. and J.G.P.-G.; review and editing, D.V.-D., P.S.-A., J.C.-P., A.P.-B., M.R.-R., A.M.-G., A.M.-d.-O.-G., A.G.-M. and J.G.P.-G. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by University of Cádiz, grant number PR2016-051; PR2019-054; Biomedical Research and Innovation Institute of Cadiz, grant number LI19/21IN-CO09; Government of Spain, grant number MCIN/AEI/10.13039/501100011033/PID2019-110063RA-I00; Junta de Andalucía, grant number DGP_POST_2024_00864; and Instituto de Salud Carlos III, grant number CD25/00165.

Institutional Review Board Statement

This study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethical Committee of the Hospital Puerta del Mar (Cadiz, Spain). The code of approval was 1590 13-B, and the date of approval was 28 September 2017.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author(s).

Acknowledgments

We would like to extend our gratitude to the research team behind the “NutAF” project, as well as the participants who made this study possible.

Conflicts of Interest

The authors declare no conflicts of interest.

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Table 1. General characteristics and energy expenditure of the NutAF study participants.
Table 1. General characteristics and energy expenditure of the NutAF study participants.
Variable N Total Men (n=47) Women (n=27) p Cohen’s d
Age (years) 74 22.65 ± 4.18 22.45 ± 3.54 23.00 ± 5.16 0.293 -0.13
Height (cm) 74 171.68 ± 8.38 175.87 ± 6.16 164.37 ± 6.53 <0.001 1.83
Body mass (kg) 74 75.24 ± 14.54 77.21 ± 12.55 71.81 ± 17.21 0.063 0.38
BMI (kg·m⁻²) 74 25.61 ± 5.42 24.95 ± 3.73 26.76 ± 7.46 0.084 -0.34
Total energy expenditure (kcal·day⁻¹) 74 2361.12 ± 411.25 2536.40 ± 359.53 2056.00 ± 306.49 <0.001 1.41
Resting metabolic rate (kcal·day⁻¹) 74 1841.44 ± 310.97 1987.59 ± 253.08 1587.04 ± 228.86 <0.001 1.64
Energy balance (kcal·day⁻¹) 73 146.63 ± 695.25 174.78 ± 716.89 98.67 ± 667.31 0.327 0.11
Values are presented as mean ± standard deviation. Differences between men and women were assessed using independent samples t-tests. Cohen’s d was used to estimate effect size. Energy balance was calculated as energy intake minus total daily energy expenditure. Statistical significance was set at p < 0.05. Bold values indicate statistical significance (p < 0.05).
Table 2. Macronutrient adequacy ratios (NAR) of the NutAF study participants.
Table 2. Macronutrient adequacy ratios (NAR) of the NutAF study participants.
Variable N Total Men (n=47) Women (n=27) p Cohen’s d
NAR – Carbohydrates (g) 74 81.57 ± 28.06 81.48 ± 25.13 81.74 ± 33.05 0.485 -0.01
NAR – Starch (g) 74 49.46 ± 17.72 49.49 ± 16.69 49.39 ± 19.72 0.492 0.01
NAR – Simple sugars (g) 74 169.05 ± 83.17 166.76 ± 65.29 173.02 ± 108.88 0.394 -0.08
NAR – Total lipids (g) 74 162.40 ± 61.60 162.16 ± 62.67 162.82 ± 60.86 0.482 -0.01
NAR – Saturated fatty acids (g) 74 144.08 ± 57.17 139.93 ± 49.01 151.31 ± 69.58 0.229 -0.20
NAR – Monounsaturated fatty acids (g) 74 38.88 ± 14.55 37.54 ± 13.81 41.22 ± 15.74 0.164 -0.25
NAR – Polyunsaturated fatty acids (g) 74 12.14 ± 5.26 11.84 ± 4.96 12.67 ± 5.75 0.277 -0.15
NAR – Proteins (g) 74 113.90 ± 31.60 114.38 ± 31.55 113.08 ± 32.27 0.434 0.04
NAR – Total fiber (g) 74 21.69 ± 8.88 20.65 ± 6.92 23.44 ± 11.47 0.104 -0.30
NAR – Water (g) 74 95.42 ± 28.92 92.79 ± 30.90 100.01 ± 24.98 0.139 -0.25
Values are presented as mean ± standard deviation. Differences between men and women were assessed using independent samples t-tests. Cohen’s d was used to estimate effect size.
Table 3. Micronutrient adequacy ratios (NAR) of the NutAF study participants.
Table 3. Micronutrient adequacy ratios (NAR) of the NutAF study participants.
Variable n Total Men (n=47) Women (n=27) p Cohen’s d
NAR – Calcium (mg) 74 1261.20 ± 489.01 1225.17 ± 485.01 1322.15 ± 499.92 0.230 -0.20
NAR – Iron (mg) 74 16.78 ± 5.08 16.32 ± 4.78 17.55 ± 5.56 0.202 -0.24
NAR – Magnesium (mg) 74 418.92 ± 153.88 416.71 ± 144.62 422.85 ± 170.34 0.434 -0.04
NAR – Zinc (mg) 74 10.94 ± 3.58 10.77 ± 3.20 11.23 ± 4.16 0.353 -0.12
NAR – Potassium (mg) 74 3736.95 ± 1235.24 3741.91 ± 1212.74 3728.07 ± 1290.01 0.486 0.01
NAR – Sodium (mg) 74 2961.20 ± 1240.67 2924.45 ± 1173.35 3025.52 ± 1368.92 0.370 -0.08
NAR – Selenium (µg) 74 96.77 ± 34.80 95.70 ± 35.66 98.62 ± 33.69 0.397 -0.08
NAR – Vitamin A (µg) 74 1135.51 ± 513.77 1152.14 ± 529.62 1107.05 ± 492.10 0.394 0.09
NAR – Vitamin D (µg) 74 4.17 ± 2.25 3.87 ± 2.01 4.69 ± 2.51 0.050 -0.36
NAR – Vitamin E (mg) 74 13.61 ± 4.62 13.68 ± 4.30 13.48 ± 5.17 0.452 0.04
NAR – Vitamin C (mg) 74 152.57 ± 91.98 146.21 ± 84.96 163.76 ± 103.53 0.262 -0.18
NAR – Vitamin B1 (mg) 74 2.11 ± 0.62 2.08 ± 0.57 2.16 ± 0.70 0.378 -0.12
NAR – Vitamin B2 (mg) 74 2.21 ± 0.74 2.18 ± 0.68 2.27 ± 0.84 0.391 -0.12
NAR – Vitamin B3 (mg) 74 25.21 ± 8.62 25.37 ± 7.89 24.99 ± 9.86 0.436 0.05
NAR – Vitamin B6 (mg) 74 2.72 ± 0.95 2.71 ± 0.94 2.73 ± 0.98 0.483 -0.02
NAR – Vitamin B9 (µg) 74 388.80 ± 144.91 377.80 ± 129.70 407.94 ± 169.99 0.238 -0.20
NAR – Vitamin B12 (µg) 74 5.06 ± 2.80 5.11 ± 2.58 4.99 ± 3.16 0.454 0.04
Values are presented as mean ± standard deviation. Differences between men and women were assessed using independent samples t-tests. Cohen’s d was used to estimate effect size. Statistical significance was set at p < 0.05. Bold values indicate statistical significance (p < 0.05).
Table 4. Prevalence of compliance of the dietary recommendations for macronutrients in the NutAF study participants.
Table 4. Prevalence of compliance of the dietary recommendations for macronutrients in the NutAF study participants.
Variable % Meeting recommendations N Mean adequacy (%) SD
Water 44.6 33 43.6 22.7
Carbohydrates 21.6 16 14.4 14.9
Starch 0.0 0 19.7 22.3
Simple sugars 82.4 61 92.8 24.7
Proteins 63.5 47 71.6 6.5
Total lipids 94.6 70 97.3 10.6
Saturated fatty acids 82.4 61 82.8 20.4
Monounsaturated fatty acids 98.6 73 118.8 12.1
Polyunsaturated fatty acids (ω-6) 6.8 5 19.2 5.6
Polyunsaturated fatty acids (ω-3) 1.4 1 8.1 17.7
Total fiber 50.0 37 43.5 19.6
Data are presented as the percentage of individuals meeting the recommended intakes (% meeting recommendations), the number of individuals who meet the recommendations (n), the mean percentage of adequacy relative to the recommendations (mean adequacy, %), and standard deviation (SD).
Table 5. Prevalence of compliance of the dietary recommendations for micronutrients in the NutAF study participants.
Table 5. Prevalence of compliance of the dietary recommendations for micronutrients in the NutAF study participants.
Variable % Meeting recommendations N Mean adequacy (%) SD
Calcium 36.5 27 41.4 20.2
Iron 74.3 55 62.1 19.1
Magnesium 39.2 29 30.9 5.5
Zinc 63.5 47 69.2 11.6
Potassium 28.4 21 35.4 7.2
Sodium 87.8 65 100.5 21.0
Selenium 90.5 67 111.3 7.8
Vitamin A 50.0 37 58.8 17.8
Vitamin D 9.5 7 10.4 7.3
Vitamin E 32.4 24 26.8 16.2
Vitamin C 50.0 37 43.5 19.6
Vitamin B1 91.9 68 94.6 15.9
Vitamin B2 60.8 45 51.6 6.3
Vitamin B3 100.0 74 110.0 12.8
Vitamin B6 81.1 60 81.4 9.0
Vitamin B9 (folate) 23.0 17 36.2 20.4
Vitamin B12 81.1 60 88.5 5.1
Data are presented as the proportion of individuals meeting the recommended intakes (% meeting recommendations), the number of individuals who meet the recommendations (n), the mean percentage of adequacy relative to the recommendations (mean adequacy, %), and the standard deviation (SD).
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