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

More documents

Recommendations

Info

S56 the prevalence of intakes outside the range is high, then some type of intervention might be considered. The prevalence that is a cause for concern could vary among countries or regions, but prevalences greater than 2% to 3% would be consistent with the use of values like the INL 98 for other nutrients. Because this type of assessment is using the AMDR to define cutpoints, it is essential that the intake distribution be adjusted for day-to-day variation first. Pitfalls to avoid When NIVs are used to assess the intakes of groups, there are several errors to avoid [18]. In the past, the intakes of groups were evaluated by comparing the mean intake with the INL 98 and assuming that the prevalence of inadequacy was low if the mean was equal to or greater than the INL. However, it can be shown that this assumption was almost always incorrect due to the large variation in nutrient intakes. Because intakes are more variable than requirements, a substantial proportion of the group still has intakes below the ANR, even if the mean intake is equal to the INL 98 . Typically, a prevalence of inadequacy of 25% or more may be observed in this case. For the prevalence of inadequacy to be low (less than 5% to 10%), the mean intake must usually be well above the INL 98 . For this reason, it is preferable to use either the probability approach or the cutpoint method to calculate a more accurate estimate of the prevalence of inadequacy for the group. Likewise, it is not helpful to compare the mean intake of a group with the ANR. If the mean intake is equal to the ANR, then the prevalence of inadequacy is 50%. Group intake distributions must be adjusted to remove the effect of day-to-day variation in intakes. Unless such an adjustment is made, the prevalence of inadequacy, the prevalence of excessive intakes, and the prevalence of intakes outside the AMDR will not be correctly estimated. Intakes must be accurately assessed, and the conversion of food intakes to nutrient intakes must use appropriate food-composition tables (both of these topics are covered in more detail below). Planning nutrient intakes for groups Goal The goal of planning the nutrient intakes for groups is to minimize the prevalence of inadequate intakes and also to minimize the prevalence of potentially excessive intakes [3, 19]. Using the cutpoint approach to plan intakes The cutpoint approach, described above for assessing the intakes of groups, is also useful for planning the intakes of groups. To minimize the prevalence of inadequate intakes, the planner would try to minimize the proportion of the group with intakes below the ANR. As noted earlier, the cutpoint approach may be used for all nutrients with an ANR and a symmetrical requirement distribution. It also assumes that the distribution of intakes is greater than the distribution of requirements, although this assumption is seldom violated among free-living groups. To minimize the prevalence of excessive intakes, the planner would try to minimize the proportion of the group with intakes above the UNL. Steps in planning intakes S. P. Murphy and H. H. Vorster Planning diets for groups using the cutpoint approach consists of several steps [3, 19]. 1. Decide the exact goals for the planning process. This involves deciding what prevalences of inadequacy and prevalences of usual intakes above the UNL are acceptable. Although it might be considered ideal to have only 2% to 3% of the group below the ANR or above the UNL, these may not be practical goals in some situations. 2. Select the target distribution of usual intakes that meets these goals. In order to select this target distribution, it is usually necessary to know the current intake distribution so that the need for change can be assessed. In some cases, the intake distribution may already be acceptable (i.e., very few intakes are below the ANR or above the UNL). In other situations, it may be necessary to increase intakes (i.e., move the current distribution to the right) so that fewer people would fall below the ANR, or it may be necessary to decrease intakes (move the current distribution to the left) so that fewer people are above the UNL. 3. Plan menus or food patterns that achieve these goals for all of the nutrients of concern. This will usually require the use of dietary assessment software that will use an appropriate food-composition table to calculate the nutrient content of a menu. The goal might be for the menu to provide nutrient levels at the midpoint of the target distributions that were chosen for each nutrient. The foods and amounts that will actually be consumed, not just those provided by the menus, should also be considered. 4. Because there are many uncertainties in the planning process, it is usually essential that the results be assessed after the menus or food patterns are implemented. If the planning goals are not met, then it may be necessary to repeat these steps until the results are satisfactory. Planning using the AI For nutrients with an NIV, such as an AI, intakes should be planned so that the mean amount consumed by the group is equal to the AI. The distribution of intakes does not need to be planned for these nutrients.
Using nutrient intake values to assess intakes Planning energy and macronutrient intakes The mean amount of energy provided should be approximately equal to the estimated mean energy requirement for the group. The distribution of intakes does not need to be planned for energy intake. For macronutrients with AMDRs, the planning goal is to minimize the prevalence of intakes outside this range. It may be useful to examine the current distribution of the percentage of energy from each macronutrient and decide if these distributions should be changed. Planning for heterogeneous groups The steps outlined above assume that the individuals within the group are similar in age and sex, so a single set of ANRs and UNLs can be used for the planning process. Planning for groups that are not homogeneous is more difficult. One approach for such groups is to identify the subgroup with the greatest nutrient requirement per 1,000 kcal (i.e., the subgroup that requires the most nutrient-dense diet) and then use the procedures described above to plan intakes for each nutrient. The assumption is made that a diet that is adequate for this subgroup will also be adequate for the other subgroups if they meet their energy requirements. The possibility of potentially excessive intakes by some subgroups should also be considered. Finally, it is particularly important to check the actual nutrient intake distributions after the new menus or food patterns have been implemented, to ensure that all subgroups have a low prevalence of inadequacy and a low prevalence of potentially excessive intakes. An alternative procedure is to estimate the nutrient density distribution for S57 the whole group and to plan using this distribution. Although this approach is theoretically preferable, the methods are still under development [3]. Examples of assessing and planning intakes using NIVs Following are several examples of appropriate uses of the NIVs for assessing and planning nutrient intakes. The first two illustrate how the intakes of a hypothetical 30-year-old man might be assessed (table 1) and what changes might be recommended in planning his intake (table 2). Intakes of thiamin and folate were well above the ANR and had a 98% probability of adequacy if observed intake was the same as usual intake. However, the confidence of adequacy for usual intake was reduced to 70% and 80%, respectively, because intake was observed for only three days. Riboflavin intake had only a 50% probability of adequacy because intake was equal to the ANR. Observed phosphorus intake was very high and had a 100% probability of adequacy. However, because observed intake was close to the UNL of 4,000 mg/d, the confidence that usual intake was below the UNL was only 80%. Assuming that the three days of intake reflected his usual intake, the individual would be advised to increase his riboflavin and zinc intakes (table 2). If these days were not typical, then it would be appropriate to collect additional days of intake data in order to better evaluate thiamin, folate, and phosphorus intakes. To make these recommendations meaningful to a consumer, food-based TABLE 1. Assessing the nutrient intakes of a hypothetical individual (30-year-old man; intakes observed for 3 days) a Nutrient Intake ANR Probability of adequacy Confidence of adequacy UNL Confidence intake is < UNL Thiamin (mg/day) 1.3 1.0 98 70 None N/A Riboflavin (mg/day) 1.1 1.1 50 50 None N/A Folate (µg/day DFE) 400 320 98 80 1,000 100 Zinc (mg/day) 10.3 9.4 86 65 40 100 Phosphorus (mg/day) 3,800 580 100 100 4,000 80 DFE, dietary folate equivalent; ANR, average nutrient requirement; UNL, upper nutrient level a. Using the dietary reference intakes (DRIs) for the United States and Canada; average nutrient requirement (ANR) = estimated average requirement (EAR); upper nutrient level (UNL) = tolerable upper intake level (UL). Adapted from Institute of Medicine [2]. TABLE 2. Planning the nutrient intakes of the same hypothetical 30-year-old individual Nutrient Current intake INL 98 UNL Recommended change in intake a Thiamin (mg/day) 1.3 1.2 None None Riboflavin (mg/day) 1.1 1.3 None Increase Folate (µg/day DFE) 400 400 1,000 None Zinc (mg/day) 10.3 11.0 40 Increase slightly Phosphorus (mg/day) 3,800 700 4,000 None DFE, dietary folate equivalent; INL, individual nutrient level; UNL, upper nutrient level a. Assumes 3-day intake reflects usual intake.
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 and 18: 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
Page 55: Using nutrient intake values to ass
Page 59 and 60: Using nutrient intake values to ass
Page 61 and 62: Determining life-stage groups and e
Page 63 and 64: Life-stage groups and nutrient inta
Page 77 and 78: The role of diet- and host-related
Page 79 and 80: Diet- and host-related factors in n
Page 101 and 102: Human nutrition and genetic variati
Page 107 and 108:
Human nutrition and genetic variati
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Application of nutrient intake valu
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Trade, development, and regulatory
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Beyond recommendations: Implementin
Page 143 and 144:
Dietary guidelines and nutrient int
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153:
International Dietary Harmonization
show all

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

Create successful ePaper yourself

Delete template?

Save as template?