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

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S70 TABLE 6. Summary of extrapolations used to determine recommended macronutrient intakes for pregnancy and lactation for all reports reviewed Agency Pregnancy Lactation Protein The EAR for age plus the amount of protein secreted in breastmilk adjusted for dietary protein utilization. RDA is the EAR plus an estimated CV of 12% Canada/USA[6] a Only for 2nd half of pregnancy: the EAR for age plus the amount for tissue deposition in mother and fetus and maintenance of the expanded protein tissue pool RDA is the EAR plus an estimated CV of 12% Addition of the amount of protein secreted in breastmilk (no adjustment for efficiency of conversion of dietary protein to milk protein owing to Caribbean [16] Adopted from WHO (1985) [9]: an increase of 6 g/day to nonpregnant allowance 25% nonprotein nitrogen in breastmilk) Recommended protein intake is derived from the amount of protein secreted in the milk and given a 70% protein utilization: D-A-CH [8] From 4th month additional * 10 g (= 58 g/day) or 6.3 g/MJ (general: upper limit for adults of protein intake at 2.0 g/kg/day) + 15 g (= 63 g/day) or 5.8 g/MJ (p32) (p32) Individual variation depending on amount of breastmilk provided: 1st 6 mo + 16 g/day 2nd 6 mo + 12 g/day Based on FAO/WHO/UNU (1985) [9], body compositional changes, increased efficiency of utilization of amino acids: Pregnancy + 10 g/day European Community [10] Finland [12] b France [14] c EAR 0.8 g/kg/day RDA 1.0 g/kg/day UL 25% (p75) Mexico [15] a Netherlands [40] d Derived from amount of nitrogen lost and additional nitrogen required for pregnancy and lactation EAR 0.7 g/kg/day RDA 0.9 g/kg/day UL 25% (p65 + 75) New Zealand/ Australia [41] e Nordic [13] 10%–20% of energy intake, based on physiological considerations 10%-20% of energy intake, based on physiological considerations S. A. Atkinson and B. Koletzko Requirements are based on protein content of milk added to value for nonpregnancy RNI: 0-4 mo: +11 g/day 4 + mo: + 8 g/day United Kingdom [17] f Requirements were calculated to allow for protein retention in the products of conception and in the maternal tissue associated with the birth of a 3.3-kg infant DRV: + 6 g/day (for 100% digestibility) Carbohydrates Canada/USA [6] a EAR for age plus fetal brain glucose utilization EAR for age plus average human milk content of carbohydrate Caribbean [16] Proportion of additional energy as carbohydrate calculated as 55%–60% Same as for pregnancy of energy
Life-stage groups and nutrient intake values D-A-CH [8] A guiding value of > 50% of dietary energy from carbohydrates is substantiated by epidemiologic findings. No special recommendations for pregnant or lactating women European Union [10] No recommendation given No recommendation given Finland [12] b France [14] c Mexico [15] a RDA 40% Netherlands [40] d Digestible carbohydrates: RDA 40%, based on the 97.5 percentile of endogenous glucose production. This remains unchanged during pregnancy; RDA is the same for pregnant and nonpregnant women (p137 + 145) New Zealand/ Australia [40] e Nordic [13] No specific recommendation No specific recommendation United Kingdom [17] f Energy EER for age plus milk energy output minus weight loss Canada/USA [6] a EER for age plus change in TEE plus pregnancy energy deposition (different for each of 3 trimesters) Caribbean [16] Additional energy suggested by WHO [9] (285 kcal/day) Energy for age plus milk energy, the energy cost of producing the milk and an assumed 80% efficiency of conversion of food energy to milk minus energy from weight loss Considering the energy contents of breastmilk, energy needs for milk synthesis and utilization of maternal endogenous fat stores during lactation, the recommended additional energy intake independent of PAL is: Up to completion of 4th month: + 2.7 MJ (635 kcal)/day After the 4th month: Full breastfeeding + 2.2 MJ (525 kcal)/day, partial breastfeeding + 1.2 MJ D-A-CH [8] f Energy requirement is calculated by considering the BMR, physical activity, thermogenesis after food intake, and needs for growth, pregnancy and lactation. Pregnant women should receive an additional 1.1 MJ (255 kcal)/day for the duration of pregnancy, independent of PAL (285 kcal)/day Energy requirements proportional to quantity of milk produced, considering the conversion efficiency of dietary energy to milk energy (now proposed 97%) and average weight loss following delivery EER estimated with BMR (WHO/FAO/UNU, 1985) [9] and PAL Thin women: 1.7 MJ/day Overweight and normal-weight women: 0.75 MJ/day from 10th week of pregnancy to reach lowest neonatal and postnatal mortality European Community [10] EAR + 2.1 MJ/day Based on energy required for the production of human milk and an average metabolic combustion of 0.5 kg of body fat/mo (method used: factorial) (p58 + 59) continued Netherlands [40] d EAR + 1.2 MJ/day Based on increased metabolic rate and reduced level of physical activity during pregnancy (method used: factorial and 2H20 18O) (p57 + 58) S71
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Contents International harmonizatio
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Executive summary Harmonization of
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Executive summary [11]. These are l
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Executive summary and converted to
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Executive summary very rapidly and
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Executive summary References Concep
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Introduction Janet C. King and Cutb
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Introduction References 1. King JC,
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Terminology and framework for nutri
Page 19 and 20: 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 61 and 62: Determining life-stage groups and e
Page 63 and 64: Life-stage groups and nutrient inta
Page 69: 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 117 and 118: Application of nutrient intake valu
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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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