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

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S74 reference values applied for fetal accretion of nutrients or nutrient composition of milk were often different; thus, variation between reports in the recommended intakes is likely. Unless geographic or racial differences can be proven for fetal accretion of nutrients or breastmilk composition, a future goal would be to standardize reference values across individual dietary standard reports. For fetal accretion of nutrients, it is important that consistent source evidence be used. Most commonly, such information is derived from the body composition of fetuses aborted or dying in the third trimester of pregnancy [42]. We recommend that when NIVs are developed for lactating women, the values for average daily milk volume provided by the WHO report on complementary feeding of young children in developing countries [38] should be used, and for milk nutrient composition the values cited in the DRI reports [5, 6, 29–32] for well-nourished women should be adopted. Future development of NIVs based on human research It is evident that further systematic scientific research is urgently required to provide adequate data on physiological nutrient requirements, especially for children and adolescents [2], pregnant and lactating women, and older adults. The opportunity is there, because methodological progress has made less invasive or noninvasive approaches available that allow ethical investigations of a number of these issues in healthy children, for example, and also in pregnant and lactating women. Therefore, it would be feasible today to narrow many of the existing gaps in knowledge in this respect, if such research were given sufficient priority both by academic institutions and by funding agencies. A clear priority for the future development of NIVs is to conduct research that will provide for internationally applicable physiological data (e.g., on absorption, distribution, deposition, metabolism, and excretion of nutrients for different sex and life-stage groups) using state-of-the-science techniques. Opportunity exists with noninvasive measurements using stable isotope tracer methodology for energy expenditure, amino acid oxidation using stable isotope breath tests for the estimation of amino acid requirements [43], and turnover of macrominerals (e.g., calcium and magnesium) and trace elements (e.g., iron and zinc). Body composition measurements to obtain data on nutrient accretion can be obtained longitudinally by methods such as dual-energy x-ray absorptiometry, total body electrical conductivity (TOBEC), and magnetic resonance imaging (MRI). Summary This review of dietary standards revealed that the approach of extrapolation to obtain nutrient recommendations is used frequently and that a great amount of inconsistency exists in the factors considered in extrapolation. The use of original research data is the preferable way to estimate nutrient requirements for different life-stage groups. However, because of the paucity of research data for some subgroups, it is often necessary to extrapolate information from other groups in order to derive estimated requirements. Extrapolation should always be a second choice, and scientists are encouraged to develop new, innovative, noninvasive methods or use existing methods, e.g., stable isotopes, to specifically determine the nutrient requirements of understudied groups, such as pregnant and lactating women, infants, children, and the elderly. Until data are available for all life-stage groups, extrapolation from one group to another is necessary. Frequently, this involves extrapolation from adults to children and adolescents and from younger adults to older adults. The rationale or scientific basis for the method chosen should be completely transparent and thoroughly described for each nutrient and life-stage group. It is likely that different approaches will be used for different nutrients and different extrapolations for a single nutrient. There is no one “correct” method of extrapolation and scientific judgment will probably be part of the process. Examples of approaches to extrapolation models include adjustments for body size (weight or metabolic weight), energy intakes for age, or application of factorial estimates of requirements for growth, pregnancy, and lactation. However, extreme caution is advised if the extrapolation is based on energy intakes, median body weights, or activity levels, which may vary widely among populations. Note S. A. Atkinson and B. Koletzko The following reports were reviewed but, because they do not constitute nutrient-based dietary recommendations, were not included in this review: Swedish National aims and strategies for nutrition 1999–2004 [44]; National Institute of Nutrition, Hyderabad, India, Annual Report 1998–99 [45]; Socialist Republic of Vietnam, National Plan of Action for nutrition 1995–2000 [46]; Warsaw, Poland: Programme of health improvement of the Polish population through improvement of health quality of food and modification of pattern of nutrition (1996) [47]; and South African food-based dietary guidelines (2001) [48].
Life-stage groups and nutrient intake values Acknowledgments The dedicated help of Sonia Schiess in compiling data included in table 5 is gratefully acknowledged. References 1. Koletzko B, Aggett PJ, Bindels JG, Bung P, Ferre P, Gil A, Lentze MJ, Roberfroid M, Strobel S. Growth, development and differentiation: a functional food science approach. Br J Nutr 1998;80(suppl 1):S5–45. 2. Aggett P, Bresson J, Haschke F, Hernell O, Koletzko B, Lafeber HN, Michaelsen KF, Micheli J, Ormisson A, Rey J, Salazar de Sousa J, Weaver L. Recommended dietary allowances (RDAs), recommended dietary intakes (RDIs), recommended nutrient intakes (RNIs), and population reference intakes (PRIs) are not “recommended intakes.“ J Pediatr Gastroenterol Nutr 1997;25:236–41. 3. Koletzko B, de la Guéronnière V, Toschke AM, von Kries R. Nutrition in children and adolescents in Europe: What is the scientific basis? Introduction. Br J Nutr 2004;92(suppl 2):S67–73. 4. Prentice A, Branca F, Decsi T, Michaelsen KF, Fletcher RJ, Guesry P, Manz F, Vidailhet M, Pannemans D, Samartin S. Energy and nutrient dietary reference values for children in Europe: methodological approaches and current nutritional recommendations. Br J Nutr 2004;92(suppl 2):S83–146. 5. Institute of Medicine. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy Press, 1997. 6. Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academies Press, 2003. 7. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. 2000 CDC growth charts: United States, Advance Data No. 314. National Center for Health Statistics. Available at: http://www.cdc.gov/growthcharts. Accessed 28 October 2006. 8. German Nutrition Society, Austrian Nutrition Society, Swiss Society for Nutrition Research, Swiss Nutrition Association. Reference values for nutrient intake. Frankfurt/Main, Germany: Umschau Braus, 2003. 9. Energy and protein requirements. Report of a joint FAO/WHO/UNU Expert Consultation. World Health Organ Tech Rep Ser 1985;724:1–206. 10. The Scientific Committee for Food. Nutrient and energy intakes for the European Community (Opinion expressed on 11 December 1992). Luxembourg, Office for Official Publications of the European Communities. Reports of the Scientific Committee for Food (Thirtyfirst series) 1993, pp 1–248. Available at: http://europa. eu.int/comm/food/fs/sc/scf/out89.pdf. Accessed 26 November 2006. 11. National Research Council. Nutrition during pregnancy. Washington, DC: National Academy Press, 1990. 12. National Nutrition Council. Committee report. Finnish nutrition recommendations. Helsinki, Finland, 1999. 13. Nordic Nutrition Recommendations 2004, 4th ed. S75 Copenhagen, Denmark: Nordic Council of Ministers, 2005. 14. Apports nutritionnels conseillés pour la population française. AFSSA, CNERNA, CNRS, coord. Ambroise Martin. Paris: Editions Tec & Doc, 2001, 650 p. (3ème édition). Available at: http://www.inra.fr/sia2002/biblio. html. Accessed 26 November 2006. 15. Bourges H, Casanueva E, Rosado JL, eds. Recomendaciones de ingestion de nutrimentos para la población mexicana. Instituto Nacional de Nutrición. México, División de Nutrición. Publicación L-17 de la División de Nutrición. Bases fisiological. 1. Vitaminas y nutritmentos inorganico. México: Editorial Medial Panamericana, 2005. 16. Committee of the Expert Group on Caribbean Food and Nutrition Surveillance System. Recommended dietary allowances for the Caribbean. Kingston, Jamaica: Caribbean Food and Nutrition Institute, 1994. 17. Department of Health. Report on Health and Social Subjects. 41. Dietary Reference Values for Food, Energy and Nutrients for the United Kingdom. Report of the Panel on Dietary Reference Values of the Committee on Medical Aspects of Food Policy. London: Her Majesty’s Stationery Office, 1991. Available at: www.opsi.gov. uk/si/em2006/uksiem_20062381_en.pdf. Accessed 26 November 2006. 18. World Health Organization Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight and age. Acta Paediatr 2006;95(suppl 450):76–85. 19. European Commission, Health and Consumer Protection Directorate-General. Scientific Committee on Food. Minutes of the 137th Plenary Meeting of the Scientific Committee on Food held on 2/3/4 April 2003 in Brussels. SCF/CS/PLEN/MINS 137, 14 May 2003. Available at: http://www.europa.eu.int/comm/food/fs/ sc/scf/out198_en.pdf. Accessed 28 October 2006. 20. Kleiber M. Body size and metabolic rate. Physiol Rev 1947;27:511–41. 21. West GB, Brown JH, Enquist BJ. A general model for the origin of allometric scaling laws in biology. Science 1997;276:122–6. 22. Przyrembel H. Uncertainty and adjustment. FAO/WHO Nutrient Risk Assessment Workshop. Geneva: World Health Organization, 2–5 May 2005. 23. Rubner M. Über den Einfluss der Körpergrösse auf Stoff- und Kraftwechsel. Z Biol 1883;19:536–62. 24. Kleiber M. Body size and metabolism. Hilgardia 1932;6:315–53. 25. West GB, Woodruff WH, Brown JH. Allometric scaling of metabolic rate from molecules and mitochondria to cells and mammals. Proc Natl Acad Sci USA 2002;99(suppl 1):2473–8. 26. White CR, Seymour RS. Mammalian basal metabolic
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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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Page 23 and 24: Terminology and framework for nutri
Page 25 and 26: 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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