Implementing food-based dietary guidelines for - United Nations ...

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S18 intake of an essential nutrient that, on the basis of scientific knowledge, is judged by the Food and Nutrition Board to be adequate to meet the known nutrient needs of practically all healthy people. The RDA continues to be used as one of the nutrient intake values included in the US/Canadian DRIs. The RDA is based on a statistical distribution of individual requirements for meeting a chosen criterion of adequacy for the target nutrient, such as calcium, vitamin A, or protein. Based on the statistical distribution of requirements, the RDA is set at a level of intake that meets the needs of 97% to 98% of healthy individuals in a particular age- and sex-specific group. EAR (estimated average requirement) Using the same statistical distributions for nutrient requirements, the EAR is the average or mean daily nutrient intake that meets the requirement of half the healthy individuals in a particular age- and sex-specific group. AI (adequate intake) The AI is defined as the observed or experimentally derived intake by a defined population group that appears to sustain health [3–7]. An AI is used when there are insufficient primary data to establish a statistical distribution of individual requirements and, therefore, an EAR and RDA. The AI is estimated in a number of different ways. For some nutrients, it is based on the observed mean intakes of groups with an apparent low prevalence of nutrient inadequacy. For example, an AI is used to represent the nutrient intake values for infants because they were derived from the nutrients supplied by human milk. The AI has also been derived from the results of experimental studies when data were thought to be inadequate to describe a statistical distribution of requirements for a specific function or criterion. Examples include calcium, vitamin D, fluoride, and sodium. AMDR (adequate macronutrient distribution range) The AMDR specifies the upper and lower boundaries for percentage of energy from macronutrients (i.e., carbohydrate, fat, n-6 and n-3 polyunsaturated fatty acids, and protein) [6]. These boundaries are generally based on intakes associated with reducing the risk of chronic disease. UL (tolerable upper intake level) The UL is defined as the highest level of daily nutrient intake likely to pose no risk of adverse health effects for nearly all individuals in the group (general population) [9]. The level is also estimated from a statistical analysis of the risk assessment associated with a range of high nutrient intakes. The term tolerable intake was chosen to avoid implying a possible beneficial effect [9]. British terminology DRV (dietary reference value) Dietary reference values (DRVs) are nutrient-based dietary standards recommended by the United Kingdom in 1991 [10, 11]. The DRVs apply to groups of healthy people and are not appropriate for those with disease or metabolic abnormalities. As for US/Canadian DRIs, the DRVs for a nutrient assume that requirements for energy and all other nutrients are met when deriving a specific reference value. The British DRVs provide three values for most nutrients: the lower reference nutrient intake (LRNI), the estimated average requirement (EAR), and the reference nutrient intake (RNI). For some nutrients, a “safe intake” is given, and for carbohydrate and fat, individual minimum, maximum, and population averages are specified [10]. LRNI (lower reference nutrient intake) Using a statistical distribution of nutrient requirements, the LRNI is set at 2 standard deviations (SD) below the mean or average intake (EAR). EAR (estimated average requirement) The British EAR is the intake that meets the estimated nutrient needs of half of the individuals in a group, assuming a normal, statistical distribution of requirements. RNI (reference nutrient intake) This term is set at 2 SD of the requirement above the EAR and will meet the needs of 97% to 98% of the population; it is similar to the US/Canadian RDA. Safe intake A safe intake is specified for a nutrient for which there is insufficient data to determine a statistical distribution of requirements. The safe intake is judged to be a level or range of intakes at which there is no risk of deficiency and below a level where there is a risk of undesirable effects. The safe intake corresponds conceptually to the US/Canadian AI. Individual minimum, maximum, and population averages These terms are used by the British to specify recommended intakes of carbohydrate and fat [9, 10]. European Communities terminology PRI (population reference intake) J. C. King et al. This term was introduced by the Commission of the European Communities in 1993 [12] to refer to an intake acceptable for a defined age- and sex-specific group. Like the US/Canadian RDA and the British RNI, it is based on a statistical distribution of requirements for a nutrient and is set at 2 SD above the mean requirement.
Terminology and framework for nutrient intake values LTI (lowest threshold intake) This European Communities term is similar to the British LRNI and describes the mean intake minus 2 SD. Intakes below this level are assumed to be inadequate for nearly all of the individuals in a group. AR (average requirement) This term reflects the average requirement, i.e., the estimated nutrient need of half the individuals in a group; it is equivalent to the US/Canadian and British EAR. Acceptable range A range of safe intake values is given where insufficient information is available. The acceptable range is similar to the British safe intake, and the lower end of the range is similar to the US/Canadian AI. The upper end of the range is conceptually similar to the UL for the US/Canada. Dietary reference intakes for Koreans (KDRIs) Korea released a set of DRIs in 2005 [13]. Four values were proposed that are very similar to those used by the US/Canada: an estimated average requirement (EAR), recommended intake (RI), adequate intake (AI), and tolerable upper intake level (UL). They also established an AMDR (acceptable macronutrient distribution range) for the distribution of energy among the macronutrients. Southeast Asia RDAs The region of Southeast Asia, including Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, and Vietnam, released a set of recommended dietary allowances (RDAs) for their region in 2005 [14]. One nutrient intake value, an RDA, was recommended for each nutrient. In view of the limited studies done in most Southeast Asian countries, the Recommended Dietary Allowance Committee drew heavily from FAO/WHO/UNU Expert Panel reports on nutrient requirements and the US/Canadian reports on dietary reference intakes. German language societies The “reference values for nutrient intakes” (Referenzwerte für die Nährstoffzufuhr) have been established jointly by the Nutrition Societies of Germany, Austria, and Switzerland and adopted also for Slovenia [15]. Provided are average requirements (Durchschnittlicher Bedarf) for energy intake; reference intakes (Referenzwerte) for most essential nutrients (protein, n-6 fatty acids, and most vitamins, minerals, and trace elements), based on mean intakes plus assumed 2 SD of population variation, or in the absence of adequate information on standard deviation, based on mean S19 intakes plus 20% to 30%; estimated values (Schätzwerte) for nutrients where human requirements cannot be calculated with the desired accuracy, such as n-3 fatty acids, vitamin E, vitamin K, β-carotene, biotin, pantothenic acid, and some trace elements; and orientation values (Richtwerte) for nutrients where for health reasons a certain range of intakes is desirable for some substances, even though strict borderlines cannot be drawn. Lower orientation values are provided for water, fluoride, and dietary fiber and upper orientation values for total fat, cholesterol, alcohol, and salt. Australia and New Zealand Australia and New Zealand [16] recently defined a series of nutrient reference values (NRVs) broadly following the approach outlined in the US/Canadian publications on dietary reference intakes and applications in dietary assessment [3–7, 17]. thus, the terms estimated average requirement (EAR), recommended dietary intake (RDI, which is equivalent to the US/Canadian RDA), adequate intake (AI), and upper level of intake (UL) are used in the same way as defined in the US/Canadian report. To address the issue of chronic disease prevention, two additional sets of reference values were developed for selected nutrients for which sufficient evidence existed. The acceptable macronutrient distribution range (AMDR) was made as an estimate of the range of intakes for each macronutrient for individuals (expressed as percentage contribution to energy), which would allow for an adequate intake of all the other nutrients while maximizing general health outcome. The suggested dietary target (SDT) is the daily average intake from food and beverages for certain nutrients that may help in the prevention of chronic disease. These two additional sets of reference values apply only to adults and adolescents over 14 years of age. Mexico Mexico released a new edition of values for reference nutrients (valores nutrimentales de referencia [VNR]) in 2005 [18]. Four standards were recommended. The RN50 (promedio de los requerimientos nutrimentales) is the mean nutritional requirements of a population; this is equivalent to the estimated average requirement used by the US/Canadian report. The daily recommended intake (ingestión diaria recomendada [IDR]) is the value obtained by adding 2 SD to the mean of the requirements in order to cover the needs of 97.5% of the individuals in the population. If the standard deviation is unknown, the RN50 is multiplied by 1.2, assuming a coefficient of variation (standard deviation divided by the mean and multiplied by 100 to give a percentage) of 10%. The daily suggested intake (ingestión diaria sugerida [IDS]) is used in place of the IDR
Page 1 and 2: Contents International harmonizatio
Page 3 and 4: Executive summary Harmonization of
Page 5 and 6: Executive summary [11]. These are l
Page 7 and 8: Executive summary and converted to
Page 9 and 10: Executive summary very rapidly and
Page 11 and 12: Executive summary References Concep
Page 13 and 14: Introduction Janet C. King and Cutb
Page 15 and 16: Introduction References 1. King JC,
Page 17: Terminology and framework for nutri
Page 21 and 22: Terminology and framework for nutri
Page 27 and 28: Nutrient risk assessment: Setting u
Page 29 and 30: Setting upper levels for nutrient r
Page 39 and 40: Establishing nutrient intake values
Page 51 and 52: Methods for using nutrient intake v
Page 53 and 54: Using nutrient intake values to ass
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Life-stage groups and nutrient inta
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The role of diet- and host-related
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Diet- and host-related factors in n
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Human nutrition and genetic variati
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Application of nutrient intake valu
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Trade, development, and regulatory
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Beyond recommendations: Implementin
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Dietary guidelines and nutrient int
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International Dietary Harmonization
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