AMERICA’S

PHYTONUTRIENT
REPORT
I M M U N E H E A LT H B Y C O L O R
 Executive Summary
Most Americans have intakes of fruit and vegetables that
fall below minimum recommended intakes. Consequently,
many Americans may be falling short in key nutrients
found in fruit and vegetables, including phytonutrients.
Based on data presented in America’s Phytonutrient
Report: Quantifying the Gap, on average, 8 out of 10
American adults (76%) have a “phytonutrient gap.”
As stated in that previously released report, the
“phytonutrient gap” is defined as the percentage of
the adult population with phytonutrient intakes less
than the median intake by adults who meet government
guidelines for recommended daily intakes of fruits and
vegetables (“meeters”). In other words, the “gap”
represents the shortfall of phytonutrient intakes based
on a typical level of phytonutrient intake consistent
with a diet that is considered to have a prudent amount
of fruits and vegetables.
More specifically, a strong majority of Americans are falling
short in virtually every color category of phytonutrients:
 69% fall short in green
Includes EGCG, isothiocyanates, lutein/zeaxanthin,
and isoflavones
 74% fall short in red
Includes lycopene and ellagic acid
 83% fall short in white
Includes allicin and quercetin
 76% fall short in purple/blue
Includes anthocyanidins and resveratrol
 80% fall short in yellow/orange
Includes alpha-carotene, beta-carotene, hesperitin,
and beta-cryptoxanthin
Nutrilite’s America’s Phytonutrient Report: Immune Health by Color was developed from an analysis of dietary recall and health examination data from the National Health and Nutrition Examination Survey (NHANES),
an ongoing survey designed to assess the health and nutritional status of the U.S. population. This analysis was completed by Exponent for Nutrilite in June 2010.
1
The present extension report, entitled America’s
Phytonutrient Report: Immune Health by Color, explores
the relationship between fruit and vegetable consumption
patterns, and key nutrients that research suggests may
support immune health including antioxidant vitamins
(A, C and E) and trace minerals (zinc and selenium).
Key findings from the present analyses include:
 Mean intakes of vitamins A, C, E, zinc and selenium
by adults 19 years and older were consistently higher
among “meeters” compared to those who failed to
meet their recommended fruit and vegetable intakes
(“non-meeters”).
 Most notably, vitamin A intake was over 50% higher
and vitamin C intake more than double among
“meeters” compared to “non-meeters.”
Overall, consuming a wide variety of the most
phytonutrient-rich whole fruits and vegetables is the
primary dietary goal, with an emphasis on quality of
foods, not just quantity. For immune health, choosing
phytonutrient-rich fruits and vegetables across all five
color categories is particularly important because they
often contain both phytonutrients and other nutrients
associated with immune health including antioxidant
vitamins, zinc and/or selenium. Beyond this, a plant-
based dietary supplement is an option for those wishing
to fill their “phytonutrient gap” year round, including
during cold and flu season.
 AMERICA’S PHYTONUTRIENT REPORT: IMMUNE HEALTH BY COLOR

Introduction
The immune system, comprised of both innate
and adaptive immunity, is the body’s defense
system designed to protect it against harmful
substances such as bacteria and viruses. Innate
immunity is non-specific and offers general
protection from birth, while adaptive immunity
is specific to a potentially harmful substance
(antigen), and is acquired over time. With normal
aging, both the innate and adaptive immune
response can become less effective, leading
to an increased susceptibility to illness and/or
infections such as the common cold or influenza.
It has been estimated that Americans experience
between two and four colds annually lasting
anywhere between seven and ten days.1 This
results in approximately 23 million absentee
days from work,2 with a total economic impact
of $40 billion annually.3 While $2 billion is spent
annually on over-the counter medication to help
treat the common cold,2 consuming foods higher
in nutrient value may also help prevent illness
during cold and flu season. Without proper
nutrition, the immune system may lack the
necessary nutrients to produce an effective
immune response.
While this report will refer to several markers of
cellular immune response such as natural killer
(NK) cells which seek out and destroy germs
and beta (B) cells which produce antibodies
that destroy bacteria, these analyses are not
designed to cover specific detail about the
immune response itself. Rather, this report
is an exploration of the relationship between
fruit and vegetable consumption patterns,
with a focus on select nutrients that research
suggests may support immune health including
three antioxidant vitamins (A, C and E) and two
trace minerals (zinc and selenium).
The “Phytonutrient Gap” Defined
Because phytonutrients are not considered “essential” to human health, there
are no corresponding Dietary Reference Intakes (DRIs), like there are for the
macro and micronutrients. To be clear, the America’s Phytonutrient Report
research series is not designed to determine the ideal or even adequate intake
level of any phytonutrient for immune health or any other health parameter.
Rather, the reports are based on the identification of the median dietary intake
of phytonutrients by the subpopulation of adults who meet their fruit and vegetable
intake recommendations (“meeters”). The “phytonutrient gap” is defined as the
percent of the total population with phytonutrient intakes less than the median
intake for the select phytonutrients of interest. In other words, this “gap” represents
the shortfall of phytonutrient intakes based on a reference level of phytonutrient
intake consistent with a “prudent diet” which is high in fruits and vegetables.
It is important to point out that a “prudent diet” may still fall short of desirable
or optimal levels of some or even most phytonutrients found in fruits, vegetables,
and other plant sources such as teas and nuts.
America’s Phytonutrient Report: Quantifying the Gap4 looked at 14 select
phytonutrients including carotenoids (lutein/zeaxanthin, lycopene, alpha-carotene,
beta-carotene, beta-cryptoxanthin), flavonoids (anthocyanidins, epigallocatechin
3-gallate [EGCG], hesperitin, quercetin), phenolics (ellagic acid, resveratrol),
isothiocyanates, isoflavones and allicin in order to determine gaps in consumption.
The “phytonutrient gaps” by color based on the original America’s Phytonutrient
Report: Quantifying the Gap are listed in Table 1.
Table 1: “Phytonutrient Gaps” by Color Category
PERCENT OF
COLOR
PHYTONUTRIENT AMERICAN ADULTS WITH
CATEGORY
A PHYTONUTRIENT GAP
EGCG
Isothiocyanates
GREEN 69
Lutein/zeaxanthin
Isoflavones
Lycopene
RED 74
Ellagic Acid
Allicin
WHITE 83
Quercetin

Anthocyanidins
PURPLE/
76
BLUE
Resveratrol

Alpha-carotene

YELLOW/ Beta-carotene
80
ORANGE Hesperitin
Beta-cryptoxanthin

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AMERICA’S PHYTONUTRIENT REPORT: IMMUNE HEALTH BY COLOR

The Antioxidant Response

Antioxidant nutrients appear to play a pivotal role in maintaining the reduction-oxidation
balance (“redox”) in immune cells to preserve their healthy functioning.5 Cells of the
immune system are particularly sensitive to changes in redox balance because of the
higher percentage of polyunsaturated fatty acids in their plasma membranes. Additionally,
immune system cells generally have higher concentrations of antioxidants than do other
cells.6 For these basic reasons, inadequate levels of various antioxidant nutrients may
adversely affect the immune response in humans.

For the purposes of this report, three antioxidants vitamins and two trace minerals have Immune system cells generally
been identified because of their potential role in enhancing immune health within
the context of prudent intakes of fruit and vegetables. The recommended dietary have higher concentrations
allowances (RDAs) have been set for these vitamins and trace minerals by the Institute
of Medicine (IOM) as shown in Table 2: of antioxidants than do other cells
Table 2: Recommended Dietary Allowances (RDAs)
for Vitamins A, C, and E, Zinc and Selenium

RDAa
NUTRIENT
MALES 19+ YEARS FEMALES 19+ YEARS b

VITAMIN A (mcg RAE/d) 900 700

VITAMIN C (mg/d) 90 75

VITAMIN E (mg α-toc/d) 15 15

ZINC (mg/d) 11 8

SELENIUM (mcg/d) 55 55

a
Institute of Medicine (IOM), Food and Nutrition Board. 2000. Dietary Reference Intakes for
Vitamin C, Vitamin E, Selenium, and Carotenoids.
Institute of Medicine (IOM), Food and Nutrition Board. 2001. Dietary Reference Intakes for
Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybde-
num, Nickel, Silicon, Vanadium, and Zinc.
b
Excluding pregnant and lactating females

Methodology & Data Sourcing

In the current analysis, intakes of vitamins A, C, E, zinc and selenium were estimated
from food consumption records collected as part of the National Health and Nutrition
Examination Surveys (NHANES) conducted in 2003-2004 and 2005-20067,8 and
nutrient concentration data compiled by the USDA for the surveys. The USDA’s Food
and Nutrient Database for Dietary Studies 3.0 (FNNDS 3)9 was the primary source
of nutrient concentration data. An earlier release of the FNNDS (2.0)10 was used
to identify the nutrient concentration data for foods consumed only during the
2003-2004 period. Using these nutrient data, 2-day average intakes were estimated
by the populations of “meeters” and “non-meeters.”

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 AMERICA’S PHYTONUTRIENT REPORT: IMMUNE HEALTH BY COLOR

Tracking Immunity Nutrient Intakes Among Fruit

and Vegetable Consumers
While the deep complexities of the research covering any relationships between innate and acquired
immunity with phytonutrients from fruits, vegetables and other plant-based foods is beyond the scope
of this report, these analyses indicate a basic finding that individuals who meet their fruit and vegetable
intake recommendations (“meeters”) on average consume higher levels of vitamins A, C and E, zinc
and selenium than “non-meeters.” The 2-day average intakes are shown in Table 3.

Table 3: 2-Day Average Intakes by “Meeter” and “Non-Meeter” Status

of U.S. Adults Age 19+ Years

“MEETER”a “NON-MEETER”
(N=501) (N = 7571)
NUTRIENT
MEAN 50TH PERCENTILE MEAN 50TH PERCENTILE

VITAMIN A (mcg RAE/d) 998 900 628 520

VITAMIN C (mg/d) 185 172 82 63

VITAMIN E (mg α-toc/d) 10.6 9.6 7.2 6.3

ZINC (mg/d) 14.7 13.4 12.3 10.8

SELENIUM (mcg/d) 128 115 110 101

a
Meet recommended intakes of fruits and vegetables as defined by MyPyramid food guidance (www.mypyramid.gov).

Of all the nutrients examined, the greatest difference in intakes between “meeters” and “non-meeters”
was found for vitamins A and C, two nutrients particularly concentrated in fruits and vegetables.
As shown, the mean vitamin A intake was over 50% higher and the mean vitamin C intake more than
double among “meeters” compared to “non-meeters.”

On average, “meeters” consume

higher levels of vitamins A, C, E, zinc

and selenium than “non-meeters”

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AMERICA’S PHYTONUTRIENT REPORT: IMMUNE HEALTH BY COLOR
The following sections outline the select antioxidant vitamins and trace minerals included in this report.
Each section identifies the top food sources in the diet of American adults based on a published analysis
of dietary intake data collected in 1994-1996,11 as well as an overview of the existing peer-reviewed
literature on the effects of these vitamins and trace minerals on immune health.
T H E A N T I O X I D A N T V I TA M I N S
Vitamin A
Research: The “anti-infective” properties of vitamin A play a vital role
in the maintenance and functioning of both the innate and adaptive
immune systems.12 And while vitamin A is not generally associated
with cold and flu season directly, like vitamin C for example, research
suggests vitamin A deficiency interferes with normal regeneration of
mucosal barriers damaged by infection, and is associated with recur-
rent infections.13 Further, vitamin A plays a role in the development
of both T-helper (Th) cells and B cells; a deficiency of which could
lead to diminished antibody-mediated responses.14 Previous studies
of both humans and animals have shown that vitamin A deficiency
results in increased severe infection incidence and mortality,
particularly among children in lesser developed countries.15,16
Food Sources: Based on a published analysis of key nutrient
sources in the diets of American adults,11 carrots were the primary
source of vitamin A (measured in IUs/day) in the diet, contributing
38.6% of total intake of the nutrient from food sources. Other top
vegetable sources of vitamin A included tomatoes (6.1%), spinach
and salad greens (5.1%), sweet potatoes (4.6%), and tomato and
vegetable juices (2.2%).
The plant-based food sources which contribute vitamin A in the
diet also contribute phytonutrients from multiple color categories.
For example, carrots contain beta-carotene (yellow/orange group),
tomatoes contain lycopene (red group), and spinach contains lutein
(green group). Essentially then, within the context of the “phytonutri-
ent gap” color paradigm, three of the five color categories are of
importance when seen in the context of vitamin A-containing foods.
5
Vitamin C
Research: Vitamin C has been shown to stimulate white blood cell
functions, and may play a significant role in the regulation of the
inflammatory response. Such mechanisms may include the inhibition
of proinflammatory cytokines or the inhibition of T-cell apoptosis-
signaling pathways.6
Since the 1940s, numerous studies have examined the use of vitamin
C both as a prophylaxis and as a treatment for the common cold;
results have been mixed. For example, a meta-analysis of 55 trials
(15 statistical comparisons) looked at the severity of cold symptoms
and showed that those taking vitamin C had fewer days confined to
the home or off from work or school.17 Another meta-analysis of 21
studies showed a 23% reduction in duration of episodes and severity
of symptoms in patients taking at least 1g per day of vitamin C.18
In contrast, a five year randomized controlled trial among mid to older
aged Japanese adults supplementing their diets with 5 to 500 mg
per day of vitamin C showed no effect on duration or severity of
colds; however the 500 mg per day group had significantly reduced
cold frequency.19
Food Sources: Based on a published analysis of key nutrient
sources in the diets of American adults,11 the primary food source
of vitamin C was orange/grapefruit juice, with these juices providing
23.8% of total vitamin C intake (measured in mg/day). Other top
fruit sources included fruit drinks (10.0%), oranges/tangerines
(4.1%), other non-citrus juice sources (2.5%), and cantaloupe
(2.4%). Key vegetables sources of vitamin C included tomatoes
(9.9%), peppers (6.7%), white potatoes (5.8%), and broccoli (5.7%).
The plant-based food sources which contribute vitamin C in the diet
also contribute phytonutrients from multiple color categories. For
example, oranges also contain hesperitin (yellow/orange group),
tomatoes contain lycopene (red group), and broccoli contains
isothiocyanates (green group). Similar to vitamin A, three of the
five color categories are of importance when seen in the context
of vitamin C-containing foods.
 AMERICA’S PHYTONUTRIENT REPORT: IMMUNE HEALTH BY COLOR
Vitamin E
Research: It is hypothesized that vitamin E may stimulate the production
of NK cells and enhance the production of B cells, though some studies
have failed to show an association between vitamin E and immunity.20, 21
Other research suggests supplementation with vitamin E improves
several markers of immune response. For example, two studies testing
supplementation between 200 mg – 800 mg per day of vitamin E
yielded improvements in interleukin 1 (IL-1), interleukin 2 (IL-2) and
delayed-type hypersensitivity (DTH), suggesting supplementation
may improve immune responsiveness in some populations.22,23 Related
results have also shown a protective benefit against upper respiratory
tract infections. Supplementation of 200 IU per day of vitamin E yielded
a 20% reduced risk for acquiring a cold among nursing home residents
over the course of one year.24
TH E TRACE M I N E RALS
Zinc
Research: Zinc has been shown to increase the production of white
blood cells such as macrophages and neutrophils, and to help these
cells release more antibodies to better fight infection. Thus, lowered
zinc status has been associated with impairment in both white blood
cell function and NK cell activity. The observation that rhinovirus (the
virus causing the common cold) replication is inhibited by zinc further
establishes the therapeutic role for zinc against the common cold.25
In a large cross-over study, adults were given a placebo for three
months, followed by 30 mg per day of zinc for six months. Results
showed that supplementation improved both DTH and IL-1 produc-
tion.26 In addition, a small randomized, controlled trial found that
treatment with zinc acetate in the form of lozenges was associated
with a decrease in the duration and severity of cold symptoms,
especially coughing.27 Supplementation studies using zinc gluconate
(instead of zinc acetate) did not yield significant findings.28,29
Food Sources: While zinc can be found in shitake mushrooms,
most fruits and vegetables are relatively poor dietary sources of zinc.
However, some plant-based foods do contribute zinc to the diet.
Based on a published analysis of key nutrient sources in the diets
of American adults,11 dried beans and lentils accounted for 2.5%
of total zinc intake and nuts and seeds provided 1 – 2% of total
intake (measured in mg/day).
Food Sources: Based on a published analysis of key nutrient sources
in the diets of American adults,11 fruits and vegetables accounted for
a relatively small percentage of total intakes of vitamin E (measured
in mg vitamin E/day). Tomatoes accounted for 7.0% of total vitamin E
intake and broccoli accounted for 1 – 2% of intake. Additionally, nuts
and seeds accounted for 4.2% of total vitamin E intake.
Selenium
Research: Selenium contributes to membrane integrity and plays an
important role in balancing the redox state.6 Selenium supplementation
among adults with a “functional deficit” resulted in more rapid
clearance of viruses and fewer virus mutations compared to the
un-supplemented group, with amounts of at least 100 mcg per day
warranted to optimize immune function.30 Selenium supplementation
also appears to stimulate immune function in those with adequate
selenium stores. In one study,11 men were fed diets either high
or low in selenium for 120 days, during which time both influenza
and diphtheria tetanus vaccines were administered. Results showed
that antibody titers against diphtheria vaccines were 2.5 times higher
on the high selenium diet. Further, cytotoxic T lymphocytes and
activated T cells were also significantly increased.31
Food Sources: While selenium can be found in spinach, most
fruits and vegetables are a relatively poor dietary source of selenium.
Based on a published analysis of key nutrient sources in the diets
of American adults,11 however, nuts and seeds accounted for
1 – 2% of total selenium intake (measured in mcg/day).
6
AMERICA’S PHYTONUTRIENT REPORT: IMMUNE HEALTH BY COLOR

Closing the “Phytonutrient Gap”

Overall, consuming a wide variety of the most phytonutrient-rich whole fruits and vegetables
is the primary dietary goal, with an emphasis on quality of foods not just quantity. For immune
health in particular, choosing phytonutrient-rich fruits and vegetables across all five color
categories is particularly important because many contain phytonutrients as well as nutrients
associated with immunity including the antioxidant vitamins, zinc and/or selenium. Of all the
nutrients examined, the greatest difference in intakes between “meeters” and “non-meeters”
was found for vitamins A and C, two nutrients particularly concentrated in fruits and vegetables.

A simple, actionable goal is to eat two servings from each of the five phytonutrient color
categories every day, for a total of 10 servings of fruits and vegetables daily. Beyond this,
a natural plant-based dietary supplement is an option for those wishing to fill their
“phytonutrient gap” year round, including during cold and flu season.

7
 AMERICA’S PHYTONUTRIENT REPORT: IMMUNE HEALTH BY COLOR
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