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

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S26 New Zealand Ministry of Health, Wellington, New Zealand. Nutrient reference values for Australia and New Zealand—Executive summary. Canberra, Australia: National Health and Medical Research Council, 2006. 17. Institute of Medicine. Dietary reference intakes: applications in dietary assessment. Washington, DC: National Academy Press, 2000. 18. Bourges HR, Casanueva E, Rosado JL. Recomendaciones de ingestion de nutrimentos para la poblacion Mexicana. Mexico: Editorial Medica Panamericana: Instituto Danone, 2005. 19. Food and Agriculture Organization/World Health Organization. Requirements for vitamin A, iron, folate and vitamin B 12 . Report of a joint FAO/WHO Expert Consultation. Rome: FAO, 1988. 20. Food and Agriculture Organization/World Health Organization/United Nations University. Energy and protein requirements. Report of a joint FAO/WHO/ UNU Expert Consultation. World Health Organ Tech Rep Ser 1985;724:1–206. 21. World Health Organization. Handbook on human nutritional requirements. Geneva: World Health Organization, 1974. 22. World Health Organization. Diet, nutrition and the prevention of chronic diseases. Geneva: World Health Organization, 2003. 23. World Health Organization/Food and Agriculture Organization. Human vitamin and mineral requirements. Rome: FAO, 2004. J. C. King et al. 24. World Health Organization. Trace elements in human nutrition and health. Geneva: World Health Organization, 1996. 25. National Research Council. Nutrient adequacy. Assessment using food consumption surveys. Washington, DC: National Academy Press, 1986. 26. Institute of Medicine. Dietary reference intakes. Applications in dietary planning. Washington, DC: National Academies Press, 2003. 27. Beaton GH. Recommended dietary intake: Individuals and populations, 9th ed. Baltimore, Md, USA: Williams & Wilkins, 1999. 28. Yates AA. Using criteria to establish nutrient intake values (NIVs). Food Nutr Bull 2007;28(suppl):S38–50. 29. Atkinson SA, Koletzko B. Determining life-stage groups and extrapolating nutrient intake values (NIVs). Food Nutr Bull 2007;28(suppl):S61–76. 30. Young VR, Scrimshaw NS. Genetic and biological variability in human nutrient requirements. Am J Clin Nutr 1979;32:486–500. 31. Beaton GH. Criteria of an adequate diet. In:Shils ME, Olson JA, Shike M, eds. Modern nutrition in health and disease. Philadelphia, Pa, USA: Lea & Febiger, 1994:1491–505. 32. Gibson RS. The role of diet- and host-related factors in nutrient bioavailability and thus in nutrientbased dietary requirement estimates. Food Nutr Bull 2007;28(suppl):S77–100.
Nutrient risk assessment: Setting upper levels and an opportunity for harmonization Peter J. Aggett Abstract Upper levels are estimates of the quantity of a nutrient that can be ingested daily over a lifetime without appreciable risk to health. The approach to establishing upper levels for nutrients, nutrient risk assessment, has derived from the risk assessment of foreign chemicals that are deliberately added to foods, or are in food as contaminants. This process of risk assessment is rigorous and transparent, particularly in dealing with the uncertainty arising from the data available and their assessment and extrapolation to human populations. Hazard identification and characterization, i.e., a dose–response pattern, as applied to xenobiotics, are discussed first, and then the difficulties of applying this approach to nutrients are reviewed. Nutrients, in contrast to foreign chemicals, have specific and selective metabolic pathways and homeostasis, as well as specific functions. This is the source of differences in the nutrient risk assessments produced by various national and international advisory bodies. Although the same data are used in such exercises, different judgments are made about identifying adverse effects, the nature of uncertainties in the assessment, and in matching the upper levels with exposure assessments and dietary reference values. The establishment of different upper levels for different national and international communities is a source of confusion in public health policy and practice and a barrier to trade. It is proposed that a basis for harmonizing the existing approaches used in nutrient risk assessment would be the collaborative development of the model for establishing upper levels of intake for nutrients and related substances that has been recently described by a Joint Task Force of the World Health Organization and the Food and Agriculture Organization. The author is affiliated with the Lancashire School of Health and Postgraduate Medicine, University of Central Lancashire, Preston, UK. Please direct queries to the author: Peter Aggett, Lancashire School of Health and Postgraduate Medicine, University of Central Lancashire, Preston, PR1 2HE UK; e-mail: pjaggett@ uclan.ac.uk. Key words: Nutrient risk assessment, upper levels, adverse health effects Introduction This contribution addresses the assessment of the risk or safety of high intakes or exposure to nutrients and related substances. I will call this nutritional risk assessment, although, of course, risk and safety assessment, and, perhaps, the approaches described in this paper, could be as readily applied to setting safe lower levels of intake. For this overview, an upper level of intake (UL) is “the maximum level of habitual intake from all sources of a nutrient or related substance judged to be unlikely to lead to adverse health effects in humans”[1]. This definition, in turn, requires at least two more definitions, setting aside that of defining a nutrient or related substance. First, an habitual intake is “the long-term average daily intake of the nutrient or substance”; second, an adverse health effect is “a change in morphology, physiology, growth, development, reproduction or lifespan of an organism, system, or (sub) population that results in an impairment of functional capacity, an impairment of capacity to compensate for additional stress, or an increase in susceptibility to other influences” [1]. A hazard is the inherent property of a nutrient or related substance to cause adverse health effects, depending on the level of intake. These definitions have been derived from the processes and definitions that have been applied to the risk analysis, risk assessment, and regulation of human exposure to xenobiotics as additives to our food, or as natural toxicants or environmental pollutants and contaminants in the food chain. Since risk assessment approaches to setting ULs for nutrients have drawn on these more established processes for nonessential chemicals, this overview will first describe these processes, and then discuss how such an approach can be applied to nutrient risk assessment. Food and Nutrition Bulletin, vol. 28, no. 1 (supplement) © 2007, The United Nations University. S27
Page 1 and 2: Contents International harmonizatio
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International Dietary Harmonization
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