International variability in diet and requirements of manganese: Causes and consequences.

Manganese (Mn) is an essential trace element that is critical for human health and development. At the turn of the century when diets were based on whole grains, cereals and other traditional foods, Mn intakes (8-9mg/d) were much greater than that prevalent today (2mg/d). As societies have developed, diets have shifted as part of a nutrition transition, to those that are high in processed foods, fat, and sugar. These foods are virtually devoid of Mn. Thus, dietary Mn has declined substantially throughout the world, as confirmed by several wide-scale, total diet studies. International variability in dietary Mn is considerable, due to tremendous diversity in food and culture. In countries where fruit and vegetable intake may be limited, i.e. the United Kingdom, populations may ingest much lower levels of Mn (1.4mg/d) as compared to Asian cultures (4mg/d) which have an abundance of plant foods in their food supply and cuisine. The bioavailability of Mn must be considered, including chemical form, oxidation state, mineral-mineral interactions, presence of dietary components and traditional food processing techniques (milling, germination, malting, fermentation). Manganese toxicity is a public health problem that results from exposure to a naturally high water source or contaminated environment of the soil and/or drinking water. In contrast, inadequate intake is associated with adverse health effects such as diabetes, metabolic syndrome, poor birth outcomes and possibly, cancer. Future studies are recommended to set dietary standards for this mineral in countries that lack recommendations to help achieve optimal health.