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

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S72 TABLE 6. Summary of extrapolations used to determine recommended macronutrient intakes for pregnancy and lactation for all reports reviewed (continued) Agency Pregnancy Lactation Based on a factorial approach, an extra energy intake of 2.0 MJ (280 kcal)/ day is recommended Nordic [13] Increased daily energy needs estimated as 1,500 kJ (350 kcal) in the 2nd trimester and 2,100 kJ (350 kcal) in the 3rd trimester, which can be at least partly covered by reduced PAL. Increased dietary energy need acknowledged but not specified Values for milk output derived from combined data from British and Swedish women, including a 4% correction to allow for insensible water losses. These values are considered representative of well-nourished women and differ from those in the FAO/WHO/UNU) [9] by less than 10% in the early months. Gross energy supplied by the mother, conversion from maternal diet to gross milk energy (80%), maternal weight loss (500 g/mo), and maternal EAR EAR: 1 mo: + 1.90 MJ or 450 kcal/day 2 mo: + 2.2 MJ or 530 kcal/day 3 mo: + 2.40 MJ or 570 kcal/day EARs recognize 2 distinct groups of breastfeeding women: Group 1: exclusive or almost exclusive breastfeeders who progressively introduce weaning food Group 2: women who introduce only limited complementary food after 3–4 mo and intend that breastfeeding provide primary source for 6 or more months United Kingdom [17] d Increase of tissue mass and metabolic activity (resulting in greater BMR and energy cost of movement): EAR + 0.8 MJ/day or 200 kcal/day only during the 3rd trimester S. A. Atkinson and B. Koletzko EAR, estimated average requirement; RDA, recommended dietary allowance; D-A-CH, Germany-Austria-Switzerland-Slovenia; CV, coefficient of variation; UL, upper tolerable limit of nutrient intake; DRV, dietary reference value; RNI, reference nutrient intake; EER, estimated energy requirement; TEE, total energy expenditure; BMR, basal metabolic rate; PAL, physical activity level a. The reports from Canada/USA [6] and Mexico [15] assumed a milk volume of 780 mL/day during lactation for the first 6 months and 640 mL/day after 6 months. b. The Finnish recommendations [12] for some nutrients are higher for pregnant and lactating women than for women of periconceptual age, but no information is provided in the report as to the basis of these special recommendations. The recommended intakes are intended for use in diet planning for groups, but it is noted that the individual requirements are often lower than the recommended intake for populations. c. In the report from France [14], the average volume of milk produced on which the recommended intake was derived for lactation was 750 to 850 mL/day. d. A committee of the Health Council has drawn up these recommendations, and the Standing Committee on Nutrition and the Standing Committee on Medicine have reviewed them [40]. e. As an interim measure, Australian Dietary Intakes [41] were adopted, and adapted where necessary for use in New Zealand. f. The Panel on Dietary Reference Values (DRVs) was set up by 1987 by the Committee on Medical Aspects of Food Policy (COMA) to review the RDAs, set in 1979. Four expert working groups reported their considerations and conclusions to the panel [17].
Life-stage groups and nutrient intake values TABLE 7. Summary of extrapolations used to determine recommended vitamin intakes for pregnancy and lactation for all reports reviewed Agency Pregnancy Lactation Vitamin A Canada/USA [28] a EAR for age plus estimated daily accumulation by fetus Caribbean [16] Add amount for maternal stores and fetal growth to nonpregnant value European Community [10] Plus 100 µg RE/day (= total 700 µg RE/day) to enhance maternal storage and provide for fetal supply. Intakes > 6,000 µg/day have been associated with birth defects Nordic [13] An additional 50 µg/day would be needed to achieve adequate accretion in fetal liver; to cover individual variation an additional 100 µg/day (total 800 µg/day) is recommended (p4 + 6) United Kingdom [17] Vitamin E Additional vitamin A supply to support fetal growth and maternal tissue growth, in line with FAO/WHO recommendations based on body pool size RNI: + 100 µg/day S73 EAR for age plus amount secreted in human milk Add amount secreted in human milk (400 µg RE/ day) in addition to nonpregnant value Plus 350 µg RE/day (= total 950 µg RE/day) based on amount secreted with human milk An additional 400 µg/day (total 1,100 µg/day) is recommended to cover average milk excretion reported in Western countries as about 350–450 µg/day To cover amounts secreted with milk RNI: 0–4 mo and 4+ mo: + 350 µg/day Canada/USA [28] a Add amount secreted in milk Caribbean [16] Add amount for fetal growth adjusted for incomplete absorption D-A-CH [8] Additional intake + 1 mg TE/day (total 13 mg TE/day) based on increased intakes of energy and polyunsaturated fatty acids European Community[10] Nordic [13] + 2 mg TE/day (2nd and 3rd trimesters) to cover additional needs United Kingdom [17] Vitamin C Add amount for vitamin E secreted in milk adjusted for incomplete absorption Additional intake + 5 mg TE/day (total 17 mg TE/day) based on increased intakes of energy and polyunsaturated fatty acids No specific recommendation No specific recommendation + 2 mg TE/day to cover secretion with milk No specific recommendation No specific recommendation Canada/USA [28] a EAR for age plus amount secreted in human milk Caribbean [16] NA D-A-CH [8] Additional intake + 10 mg/day (total 110 mg/ day), considering reduced plasma concentration and decreased body reserves during pregnancy, and bioavailability European Community [10] Additional intake + 10 mg/day (total 55 mg/day) to allow for the 50% higher fetal plasma levels and higher catabolic rate of the fetus Nordic [13] Additional intake + 10 mg/day (total 85 mg/day) to cover increased needs for fetal growth and catabolized vitamin C United Kingdom [17] Additional intake + 10 mg/day (total 50 mg/day) during the 3rd trimester to allow for the 50% higher fetal plasma levels and higher catabolic rate of the fetus Additional intake + 50 mg/day (total 150 mg/ day), to cover excretion with breastmilk Additional intake + 25 mg/day (total 70 mg/day) to cover at least 20 mg/day excreted with breastmilk, assuming 85% bioavailability Additional intake + 25 mg/day (total 100 mg/day) to cover excretion with breastmilk Additional intake + 30 mg/day (total 70 mg/day) to ensure that maternal stores are maintained and breastmilk levels are in the upper half of physiological range EAR, estimated average requirement; RE, retinol equivalent; RNI, reference nutrient intake; D-A-CH, Germany-Austria-Switzerland-Slovenia; TE, alpha-tocopherol equivalent a. The reports from Canada/USA [5, 6, 28-31] assumed a milk volume of 780 mL/day during lactation for the first 6 months and 640 mL/day after 6 months.
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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
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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
Page 61 and 62: Determining life-stage groups and e
Page 63 and 64: Life-stage groups and nutrient inta
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Page 77 and 78: The role of diet- and host-related
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Page 101 and 102: Human nutrition and genetic variati
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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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