Estimation of Dietary Intake of Inorganic Arsenic in U.S. Children

Arsenic is a natural component of the environment and is ubiquitous in soils, water, and the diet. Because dietary intake can be a significant source of background exposure to inorganic arsenic (the most toxicologically significant form), accurate intake estimates are needed to provide a context for risk management of arsenic exposure. Intake of inorganic arsenic by adults is fairly well characterized, but previous estimates of childhood intake were based on inorganic arsenic analyses in a limited number of foods (13 food types). This article estimates dietary intake for U.S. children (1 to 6 years of age) based on reported inorganic arsenic concentrations in 38 foods and in water used in cooking those foods (inorganic arsenic concentration of 0.8 μg/L), and U.S. Department of Agriculture food consumption data. This information is combined using a probabilistic software model to extract food consumption patterns and compute exposure distributions. The mean childhood dietary intake estimate for inorganic arsenic was 3.2 μg/day with a range of 1.6 to 6.2 μg/day for the 10th and 95th percentiles, respectively. For both the mean and 95th percentile inorganic arsenic intake rates, intake was predominantly contributed by grain and grain products, fruits and fruit juices, rice and rice products, and milk.     

Dietary Arsenic Intake in Taiwanese Districts with Elevated Arsenic in Drinking Water

Inorganic arsenic in dietary staples (i.e., yams and rice) may have substantially contributed to exposure and adverse health effects observed in an endemic Taiwanese population historically exposed to arsenic in drinking water. Observations of this population were used by the U.S. Environmental Protection Agency to derive toxicity values that form the basis for arsenic risk assessment and various regulations in the United States. However, data were previously insufficient to accurately estimate dietary intake. Rice and yam samples collected in 1993 and 1995 from Taiwanese districts with endemic arsenic were analyzed for total arsenic and for inorganic and organic mono and dimethylarsenic. The acid digestion techniques used in the analyses are among the best to preserve organic arsenic in the test sample. Furthermore, concurrent analyses of the proportion of inorganic arsenic in split samples of rice and yams collected in the 1995 investigation were in good agreement, despite using a different digestion method. These data support a likely mean dietary intake of 50?µg/day with a range of 15 to 211?µg/day. Consideration of dietary intake may result in a downward revision of the assumed potency of ingested arsenic as reflected in EPA's toxicity values.     

Estimation of Multimedia Inorganic Arsenic Intake in the U.S. Population

Arsenic is widely distributed in the environment by natural and human means. The potential for adverse health effects from inorganic arsenic depends on the level and route of exposure. To estimate potential health risks of inorganic arsenic, the apportionment of exposure among sources of inorganic arsenic is critical. In this study, daily inorganic arsenic intake of U.S. adults from food, water, and soil ingestion and from airborne particle inhalation was estimated. To account for variations in exposure across the U.S., a Monte Carlo approach was taken using simulations for 100,000 individuals representing the age, gender, and county of residence of the U.S. population based on census data. Our analysis found that food is the greatest source of inorganic arsenic intake and that drinking water is the next highest contributor. Inhalation of airborne arsenic-containing particles and ingestion of arsenic-containing soils were negligible contributors. The exposure is best represented by the ranges of inorganic arsenic intake (at the 10^th and 90^th percentiles), which were 1.8 to 11.4 µg/day for males and 1.3 to 9.4 µg/day for females. Regional differences in inorganic arsenic exposure were due mostly to consumption of drinking water containing differing inorganic arsenic content rather than to food preferences.     

Uncertainty in cancer risk at low doses of inorganic arsenic

It is unknown whether inorganic arsenic in drinking water concentrations at the current maximum contaminant level of 50 μg/1 poses a cancer risk in the United States. Data from two large epidemiological studies of cancer and arsenic in drinking water in Taiwan indicate a dose‐response relationship, but the magnitude of risk at low concentrations is highly uncertain. Four sources of uncertainty are described: model choice, data aggregation, intra‐village variability of arsenic in well water, arsenic intake from food. New data from an appropriately designed epidemiological study are needed to improve dose‐response assessment.     

Dietary fat increases energy intake across the range of typical consumption in the United States

Objective: The fat content of a diet has been shown to affect total energy intake, but controlled feeding trials have only compared very high (40% of total calories) fat diets with very low (20% of total calories) fat diets. This study was designed to measure accurately the voluntary food and energy intake over a range of typical intake for dietary fat. Methods and Procedures: Twenty‐two non‐obese subjects were studied for 4 days on each of three diets, which included core foods designed to contain 26, 34, and 40% fat, respectively of total calories and ad lib buffet foods of similar fat content. All diets were matched for determinants of energy density except dietary fat. Subjects consumed two meals/day in an inpatient unit and were provided the third meal and snack foods while on each diet. All food provided and not eaten was measured by research staff. Results: Voluntary energy intake increased significantly as dietary fat content increased (P = 0.008). On the 26% dietary fat treatment, subjects consumed 23.8% dietary fat (core and ad lib foods combined) and 2,748 ± 741 kcal/day (mean ± s.d.); at 34% dietary fat, subjects consumed 32.7% fat and 2,983 ± 886 kcal/day; and at 40% dietary fat subjects consumed 38.1% fat and 3,018 ± 963 kcal/day. Discussion: These results show that energy intake increases as dietary fat content increases across the usual range of dietary fat consumed in the United States. Even small reductions in dietary fat could help in lowering total energy intake and reducing weight gain in the population.     

Arsenic in Seafood: Speciation Issues for Human Health Risk Assessment

Major sources of arsenic exposure for humans are foods, particularly aquatic organisms, which are called seafood in this report. Although seafood contains a variety of arsenicals, including inorganic arsenic, which is toxic and carcinogenic, and arsenobetaine, which is considered nontoxic, the arsenic content of seafood commonly is reported only as total arsenic. A goal of this literature survey is to determine if generalizable values can be derived for the percentage of total arsenic in seafood that is inorganic arsenic. Generalizable values for percent inorganic arsenic are needed for use as default values in U.S. human health risk assessments of seafood from arsenic-contaminated sites. Data from the worldwide literature indicate the percent of inorganic arsenic in marine/estuarine finfish does not exceed 7.3% and in shellfish can reach 25% in organisms from presumably uncontaminated areas, with few data available for freshwater organisms. However, percentages can be much higher in organisms from contaminated areas and in seaweed. U.S. site-specific data for marine/estuarine finfish and shellfish are similar to the worldwide data, and for freshwater finfish indicate that the average percent inorganic arsenic is generally < 10%, but ranges up to nearly 30%. Derivation of nationwide defaults for percent inorganic arsenic in fish, shellfish, and seaweed collected from arsenic-contaminated areas in the United States is not supported by the surveyed literature.     

Utilization of commercial oilseed crops

The United States is a major producer of many different types of oilseeds, but the predominant one is soybean, that remarkable legume whose meal and oil serve many animal feed, human food, and domestic industrial product needs. More than half of the soybeans and the products produced from them are exported. The 16 mill MT of soy meal processed and fed in the United States in 1981 constituted 88% of the total oilseed meal, 71% of the high-protein feeds, and 48% of total processed feeds. Of the total soy protein available, less than 5% goes into human food products such as meat extenders, simulated meats, baked goods, dairy product analogs, dietary foods, infant foods, and fermented food products. Less than 1% of soy protein in the United States is used in industrial products, mainly as a binder for pigmented paper coatings. Of the total soy oil available, about 95% is consumed in food products such as margarines, salad oils, and cooking oils. About 5% of soy oil is applied to nonfood uses such as alkyd paints, plasticizer/stabilizers for vinyl plastics, soaps, eraser factices, and many other lesser uses. Other major oilseeds produced in the United States include cottonseed, flaxseed, peanut, safflower, and sunflower. Corn oil is produced in significant quantities as a by-product of the corn starch industry. The oilseed crops having the greatest oil productivity are peanut and sunflower. However, sunflower meal has certain deficiencies for feed and food uses. If the United States is to draw upon oilseed crops as significant contributors to feed, food, industrial products, and agricultural fuel needs, greatly improved productivity will be needed either from new oilseed crops or from improved varieties of present commercial crops.     

Global Expanded Nutrient Supply (GENuS) Model: A New Method for Estimating the Global Dietary Supply of Nutrients

Insufficient data exist for accurate estimation of global nutrient supplies. Commonly used global datasets contain key weaknesses: 1) data with global coverage, such as the FAO food balance sheets, lack specific information about many individual foods and no information on micronutrient supplies nor heterogeneity among subnational populations, while 2) household surveys provide a closer approximation of consumption, but are often not nationally representative, do not commonly capture many foods consumed outside of the home, and only provide adequate information for a few select populations. Here, we attempt to improve upon these datasets by constructing a new model—the Global Expanded Nutrient Supply (GENuS) model—to estimate nutrient availabilities for 23 individual nutrients across 225 food categories for thirty-four age-sex groups in nearly all countries. Furthermore, the model provides historical trends in dietary nutritional supplies at the national level using data from 1961–2011. We determine supplies of edible food by expanding the food balance sheet data using FAO production and trade data to increase food supply estimates from 98 to 221 food groups, and then estimate the proportion of major cereals being processed to flours to increase to 225. Next, we estimate intake among twenty-six demographic groups (ages 20+, both sexes) in each country by using data taken from the Global Dietary Database, which uses nationally representative surveys to relate national averages of food consumption to individual age and sex-groups; for children and adolescents where GDD data does not yet exist, average calorie-adjusted amounts are assumed. Finally, we match food supplies with nutrient densities from regional food composition tables to estimate nutrient supplies, running Monte Carlo simulations to find the range of potential nutrient supplies provided by the diet. To validate our new method, we compare the GENuS estimates of nutrient supplies against independent estimates by the USDA for historical US nutrition and find very good agreement for 21 of 23 nutrients, though sodium and dietary fiber will require further improvement.     

An Arsenic Exposure Model: Probabilistic Validation Using Empirical Data

This paper describes development of a multi-pathway arsenic exposure model. The model uses information on arsenic concentrations in food, water, soil, and dust, combined with estimates of intake and medium-specific absorption. Urinary arsenic is predicted assuming that 60% of absorbed arsenic is excreted in urine under steady state conditions. Fecal arsenic is predicted assuming all unabsorbed arsenic is excreted in feces. We applied this model at a former copper smelter site. Site specific distributions were available for the following parameters: soil and dust arsenic concentration (geometric mean approximately 100 to 200?ppm and 50 to 100?ppm, respectively); the combined childhood soil and dust ingestion rate (geometric mean of 20?mg/d); soil and dust arsenic relative bioavailability (geometric mean 0.20 and 0.28, respectively); exposure duration; water arsenic concentration; air arsenic concentration; and total arsenic in food. Monte Carlo simulation was used to predict daily arsenic uptake and excretion in urine and feces for children. Predicted urine arsenic levels were less than measured levels (73% to 88% of measured values, depending on region of site). On the other hand, predicted fecal arsenic levels exceeded measured levels by a factor of 1.7 to 4.6. We were able to improve the correspondence between predicted and measured arsenic excretion rates by decreasing the assumed value of the combined soil and dust ingestion rate, and increasing the assumed bioavailability of arsenic in soil and dust.     

Sensitivity Analysis of U.S. EPA's Estimates of Skin Cancer Risk from Inorganic Arsenic in Drinking Water

The current U.S. Environmental Protection Agency's (USEPA's) risk analysis on the Integrated Risk Information System (IRIS) for arsenic in drinking water is based on an epidemiological study of skin cancer in Taiwan. Assumptions used in the USEPA application of the multistage-Weibull model for risk estimation were varied to assess the effect on predicted risk of skin cancer to the U.S. population at arsenic concentrations of 1 to 50?µg/L in drinking water. Among the assumptions tested, the only notable change in risk estimates was a reduction when the arsenic concentration used as representative for Taiwan villages in the low range (<300?µg/L) was increased to the 75th percentile (245?µg/L) in place of the mean used in the USEPA analysis (170?µg/L), but the representative value for Taiwan villages in the high range (≥600?µg/L) was not increased simultaneously to the 75th percentile. Additionally, a simulation study was conducted using records of arsenic measurements in wells from the same period and region of Taiwan as the original study. The exposure-response curve estimated from 60 villages (60 data points) differed only marginally from the outcome when data were summarized into four data points (as in the USEPA skin cancer analysis). Briefly discussed are differences between the study area of Taiwan and the U.S. in nutritional status and consumption of inorganic arsenic in food that might bias predicted U.S. skin cancer risks.     

Methods for Assessment of Dietary Lead Exposure of the Inner-City Population

Abstract

Assessment of dietary lead exposure of individuals begins with the determination of food and beverage intake by the individuals, and concludes with an evaluation of the lead content of the foods and beverages consumed. Of several techniques available for assessment of dietary intake, the 24-hour food recall is recommended as the method of choice for assessing current dietary lead intakes in inner-city populations. The three-day food record can be used among cooperative and motivated subjects, while the dietary history method is available for assessing long-term intakes in the past. The unavailability of lead content values of a large number of foods will to a large extent restrict the use of these methods in large-scale dietary lead exposure studies. Until the time that such data becomes available, the most accurate estimates of lead intake can be provided by chemical analysis of duplicate samples of foods consumed, as is currently done. However, this method is feasible only for small samples.     

Homozygous loss of menin is well tolerated in liver,a tissue not affected in MEN1

In recent studies from Sweden and the United States, a high vitamin A intake has been associated with low bone mineral density (BMD) and increased fracture risk. In Sweden and the United States, food items such as milk and breakfast cereals are fortified with vitamin A, whereas in Denmark there is no mandatory fortification with vitamin A. In the present study, we investigated relations between vitamin A intake and BMD and fracture risk in a Danish population consuming mostly unfortified food items. Within a population-based cohort study in 2,016 perimenopausal women, associations between BMD and vitamin A intake were assessed at baseline and after 5-year follow-up. Moreover, associations between baseline vitamin A intake and 5-year changes in BMD were studied. Finally, fracture risk was assessed in relation to vitamin A intake. In our cohort, dietary retinol intake (0.53 mg/day) was lower than the intake reported in recent studies form Sweden (0.78 mg/day) and the United States (1.66 mg/day). Cross-sectional and longitudinal analyses showed no associations between intake of vitamin A and BMD of the femoral neck or lumbar spine. Neither did BMD differ between those 5% who had the highest, and those 5% who had the lowest, vitamin A intake. During the 5-year study period, 163 subjects sustained a fracture (cases). Compared to 978 controls, logistic regression analyses revealed no difference in vitamin A intake. Thus, in a Danish population, average vitamin A intake is lower than in Sweden and the United States and not associated with detrimental effects on bone.     

Estimating the Global Prevalence of Zinc Deficiency: Results Based on Zinc Availability in National Food Supplies and the Prevalence of Stunting

Background

Adequate zinc nutrition is essential for adequate growth, immunocompetence and neurobehavioral development, but limited information on population zinc status hinders the expansion of interventions to control zinc deficiency. The present analyses were conducted to: (1) estimate the country-specific prevalence of inadequate zinc intake; and (2) investigate relationships between country-specific estimated prevalence of dietary zinc inadequacy and dietary patterns and stunting prevalence.

Methodology and Principal Findings

National food balance sheet data were obtained from the Food and Agriculture Organization of the United Nations. Country-specific estimated prevalence of inadequate zinc intake were calculated based on the estimated absorbable zinc content of the national food supply, International Zinc Nutrition Consultative Group estimated physiological requirements for absorbed zinc, and demographic data obtained from United Nations estimates. Stunting data were obtained from a recent systematic analysis based on World Health Organization growth standards. An estimated 17.3% of the world’s population is at risk of inadequate zinc intake. Country-specific estimated prevalence of inadequate zinc intake was negatively correlated with the total energy and zinc contents of the national food supply and the percent of zinc obtained from animal source foods, and positively correlated with the phytate: zinc molar ratio of the food supply. The estimated prevalence of inadequate zinc intake was correlated with the prevalence of stunting (low height-for-age) in children under five years of age (r = 0.48, P<0.001).

Conclusions and Significance

These results, which indicate that inadequate dietary zinc intake may be fairly common, particularly in Sub-Saharan Africa and South Asia, allow inter-country comparisons regarding the relative likelihood of zinc deficiency as a public health problem. Data from these analyses should be used to determine the need for direct biochemical and dietary assessments of population zinc status, as part of nationally representative nutritional surveys targeting countries estimated to be at high risk.     

Human Exposure to Arsenic,Cadmium, Mercury,and Lead from Foods in Catalonia,Spain: Temporal Trend

The main purpose of this study was to establish the temporal trend in the daily dietary intake of arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) by the population of Catalonia, Spain. Concentrations of these elements were determined in samples of a number of food items widely consumed in that country. The dietary intake of As, Cd, Hg, and Pb was then estimated for various age–gender groups of population: children, adolescents, adults, and seniors. In the present study, the dietary intakes of As, inorganic As, Cd, Hg, methylmercury, and Pb were 328.37, 16.22, 19.47, 11.39, 10.25, and 101.47 μg/day, respectively, while in a previous (2006) survey, the dietary intakes of As, inorganic As, Cd, Hg, methylmercury, and Pb were 261.01, 33.17, 9.80, 12.61, 11.35, and 45.13 μg/day, respectively. The estimated intakes of Cd, Hg, and Pb are still notably lower than the respective PTWIs, while that of inorganic As is also lower than its BMDL₀₁. In summary, the results of this study indicate that, currently, the dietary intakes of As, Cd, Hg, and Pb should not mean additional health risks for the consumers.     

Dietary generalists and nutritional specialists: Feeding strategies of adult female blue monkeys (Cercopithecus mitis) in the Kakamega Forest,Kenya

Generalist primates eat many food types and shift their diet with changes in food availability. Variation in foods eaten may not, however, match variation in nutrient intake. We examined dietary variation in a generalist‐feeder, the blue monkey (Cercopithecus mitis), to see how dietary food intake related to variation in available food and nutrient intake. We used 371 all‐day focal follows from 24 adult females (three groups) in a wild rainforest population to quantify daily diet over 9 months. We measured food availability using vegetation surveys and phenology monitoring. We analyzed >700 food and fecal samples for macronutrient content. Subjects included 445 food items (species‐specific plant parts and insect morphotypes) in their diet. Variation in fruit consumption (percentage of diet and total kcal) tracked variation in availability, suggesting fruit was a preferred food type. Fruits also constituted the majority of the diet (by calories) and some fruit species were eaten more than expected based on relative availability. In contrast, few species of young leaves were eaten more than expected. Also, subjects ate fewer young leaves (based on calories consumed) when fruit or young leaves were more available, suggesting that young leaves served as fallback foods. Despite the broad range of foods in the diet, group differences in fiber digestibility, and variation that reflected food availability, subjects and groups converged on similar nutrient intakes (grand mean ± SD: 637.1 ± 104.7 kcal overall energy intake, 293.3 ± 46.9 kcal nonstructural carbohydrate, 147.8 ± 72.4 kcal lipid, 107.8 ± 12.9 kcal available protein, and 88.1 ± 17.5 kcal structural carbohydrate; N = 24 subjects). Thus, blue monkeys appear to be food composition generalists and nutrient intake specialists, using flexible feeding strategies to regulate nutrient intake. Findings highlight the importance of simultaneously examining dietary composition at both levels of foods and nutrients to understand primate feeding ecology.     

Dietary Silicon Intake of Korean Young Adult Males and Its Relation to their Bone Status

Accumulated data suggests a positive effect of silicon on bone health; however, limited research exists on the silicon content of foods. To further the understanding of the relationship between dietary silicon intake and bone health, a food composition database of commonly consumed foods in Korea is required. For quantitative data on the intake levels of silicon, we analyzed the silicon content of 365 food items commonly consumed in Korea using inductively coupled plasma—atomic emission spectrometry following microwave-assisted digestion. To investigate the dietary silicon intake status and to examine the potential role of dietary silicon intake in the bone status of men, a total of 400 healthy Korean adult males aged 19–25 were observed for their diet intake and calcaneus bone density using the 24-h recall method and quantitative ultrasound, respectively. Clinical markers reflecting bone metabolism such as serum total alkaline phosphatase, N-mid osteocalcin, and type 1 collagen C-terminal telopeptide concentrations were also analyzed. Silicon intake of the subjects was estimated as 37.5 ± 22.2 mg/day. Major food sources of dietary silicon in the Korean male were cereal and cereal products (25.6 % of total silicon intake), vegetables (22.7 %), beverages and liquors (21.2 %), and milk and milk products (7.0 %). Silicon intake correlated positively with age, weight, energy intake, protein intake, calcium intake, and alcohol intake. After adjusted for age, weight, energy intake, protein intake, calcium intake, alcohol intake, smoking cigarettes, and regular exercise status, daily total silicon intake had no correlation with calcaneus bone density and the bone metabolism markers, but silicon intake from vegetables had a positive correlation with serum total alkaline phosphatase activity, a bone formation maker. These findings show the possible positive relationship between dietary silicon intake from vegetables and the bone formation of young adult males. Further investigation in a larger (Korean) population and correcting for additional nutritional confounders is required to confirm these findings.     

Estimating energy and nutrient intakes in studies of human fertility.

Two methods of dietary recording, the 24-hr recall and the weighed dietary intake methods, are considered appropriate for estimating energy and nutrient intakes in studies of human fertility. The former method gives lower estimates than the latter, although weighed intakes may underestimate true intakes. Examination of food intakes of pregnant, lactating, and non-pregnant, non-lactating New Guinean women shows their diet to be less homogeneous than is generally assumed for groups in developing countries. As a result direct observations of food intake for a limited number of days are not sufficiently accurate for the estimation of intake of most of the nutrients examined. Rather the study design should reflect the variability of intakes of the nutrients and groups under consideration.     

Estimation of Excess Cancer Risk on Time-Weighted Lifetime Average Daily Intake of PAHs from Food Ingestion

The purposes of this study were to quantify the time-weighted, lifetime average, daily intake (LADI) of polycyclic aromatic hydrocarbons (PAHs) through food ingestion and to estimate the excess cancer risk based on lifetime dietary PAH intake. Twenty-seven different food commodities were selected from the 2001 Korean National Health and Nutrition survey based on their frequent consumption and high PAH level. The foods were analyzed for the profile of 14 PAH congeners using high performance liquid chromatography (HPLC) and fluorescence detector. Considering the toxic equivalent (TEQ) level converted with the toxic equivalent factors (TEFs), the highest total TEQ level of PAHs in foods was detected from roasted laver at 1.2 ug TEQ/kg. For the PAH exposure assessment according to ingested foods, the average body weight was separated according to the following age groups, 1–6, 7–19, 20–64 and over 64 years, and the daily food ingestion rates from the National Health and Nutrition survey were used. The estimated Lifetime Average Daily Intake (LADI) of PAHs was 3.22 × 10^–3 ug/kg/day for carcinogenic effects and was higher in the younger age groups under 20 years old than in the older groups. The dietary excess cancer risk estimated using the cancer potency of benzo(a)pyrene (7.3(mg/kg/day)^?1) was 2.3 × 10^?5, which is equivalent to a probability of tumor eruption in the upper gastrointestinal tract of two per hundred thousand persons.     

A Systematic Review on the Contributions of Edible Plant and Animal Biodiversity to Human Diets

The sustainable use of natural and agricultural biodiversity in the diet can be instrumental to preserve existing food biodiversity, address malnutrition, and mitigate adverse effects of dietary changes worldwide. This systematic review of literature summarizes the current evidence on the contribution of plant and animal biodiversity to human diets in terms of energy intake, micronutrient intake, and dietary diversification. Peer-reviewed studies were searched in ten databases using pre-defined search terms. Only original studies assessing food biodiversity and dietary intake were included, resulting in a total of 34 studies. 7, 14, and 17 studies reported information in relation to energy intake, micronutrient intake, and dietary diversification, respectively. In general, locally available foods were found to be important sources of energy, micronutrients, and dietary diversification in the diet of particularly rural and forest communities of highly biodiverse ecosystems. The current evidence shows local food biodiversity as important contributor of nutritious diets. Findings are, however, limited to populations living in highly biodiverse areas. Research on the contribution of biodiversity in diets of industrialized and urban settings needs more attention. Instruments are needed that would more appropriately measure the dietary contribution of local biodiversity.     

Factors Influencing the Nutritional Health and Food Choices of African American HIV-Positive Marginally Housed and Homeless Female Substance Abusers

The toll of HIV/AIDS and drug abuse on economically disadvantaged women of color in the United States is a public health problem of epidemic proportions. Malnutrition, believed to be pervasive in this population, exacerbates the devastating health effects of addiction and HIV. This study documented dietary deficiencies in this population and examined factors influencing the food choices and eating patterns of marginally housed and homeless African American HIV-positive substance abusing women. Data were collected from 28 women ages 19–55 using two 24-hour dietary recalls and a semi-structured interview guide. Data revealed multiple nutritional intake hazards including skipped meals, substitution of carbohydrate-laden foods for dairy foods rich in animal fat and proteins, and an absence of raw fruits and vegetables indicative of deficiencies in key macro- and micronutrients. Food risks were increased for homeless women who were more likely to lack public assistance, have difficulty accessing free food service, and frequently eating food from dumpsters. Qualitative data analysis of interviews generated three major themes describing the context in which nutritional deficiencies emerged: (1) diet-disease and food-safety misconceptions; (2) socio-cultural and lifestyle barriers; and (3) lack of personal resources and neighborhood food availability and affordability. The relevance of these findings to nutrition intervention programs for this population is discussed.