NUTR333-23-DRIs-1

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University of Guelph *

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333

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Oct 30, 2023

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Dietary Reference Intakes 1
Traditional Recommendations • set of reference numbers for energy and nutrients • Canada: RNI • Recommended Nutrient Intakes • USA: RDA • Recommended Dietary Allowances • revised periodically • goal is to prevent nutrient deficiencies 2
How the DRIs came about… • 1993 – FNB of the IOM of the NAS (!!) held a symposium entitled “Should the RDA’s be revised?” • 1994 – FNB published a concept paper “How should the RDA’s be revised?” – Held workshops to discuss development of nutrient-based reference values • FNB=Food and Nutrition Board • IOM=Institute of Medicine • NAS=National Academy of Science For context and interest only, do not have to study 3
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How the DRIs came about… • April 1995 – Canadian workshop to explore harmonizing with US – Consensus to approach FNB to collaborate • December 1995 – Standing committee on the Scientific Evaluation of DRI appointed – Oversees entire project structure for the DRIs For context and interest only, do not have to study 4
DRIs: overall structure (need to know) • Standing committee on the Scientific Evaluation of Dietary Reference Intakes • Two key sub-committees – Subcommittee: Upper Reference Levels of Nutrients • Publication: A risk assessment model for establishing upper intake levels for nutrients – Subcommittee: Interpretation and Uses of DRIs • Publication: DRIs: Applications in Dietary Assessment • These sub-committees facilitated the development and publication of DRI reports for individual nutrients…. 5
DRI Reports Completed • DRIs for calcium, vitamin D and related nutrients (1997) • DRIs for B-vitamins (1998) • DRIs for vitamin C, vitamin E, selenium and carotenoids (2000) • DRIs for vitamin A, vitamin K, and minerals (2001) For context and interest only, do not have to study 6
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DRI Report #2 released in 1998 • B-vitamins For interest only, do not have to study 7
DRI Reports Completed • Proposed Definition of Dietary Fibre (2001) • Electrolytes and Water (2004) • DRIs for Energy and Macronutrients (2005) For interest only, do not have to study 8
DRI Organizations Involved • Standing committee on the Scientific Evaluation of Dietary Reference Intakes – Subcommittee: Upper Reference Levels of Nutrients – Subcommittee: Interpretation and Uses of DRIs • Expert Nutrient Review Panels • The organizations involved: – Food and Nutrition Board (FNB) of the Institute of Medicine (IOM), part of the National Academy of Sciences (NAS) – Health Canada 9
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DRI overall project structure (obtained from Health Canada website) 10
Dietary Reference Intakes; what are they?? • Consist of 4 Reference Values – EAR, RDA, AI, UL • Quantitative estimates of nutrient intakes • Consider more than just preventing deficiency • Used for planning and assessing diets of healthy individuals and groups 11
Framework for Use of DRIs 12
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13 What are some examples of planning diets for a group? ⓘ Start presenting to display the poll results on this slide.
Why Change? • expanded knowledge regarding the role of nutrients in prevention of chronic disease • extend goal of recommendations beyond preventing deficiencies • incorporate chronic disease, not just deficiency disease into deciding the values • harmonize Canada and USA 14
How are the DRI’s different? • Health maintenance and risk-reduction • Four numbers versus one number • US and Canada • Will no longer be reviewed every X number of years; instead if new evidence warrants, DRIs for individual nutrients will be revised 15
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Key Concept: Criterion of Adequacy • how much of the nutrient is needed depends on what you consider is adequate • what is the criteria? • former values used classical deficiency indicators • DRI’s can take into account amount needed to reduce risk of chronic disease • criteria may differ depending on nutrient, depending on life-stage group 16
Theoretical Example: Vitamin C • potential criteria of adequacy: – prevent scurvy – saturate tissues – maximize absorption of non-heme iron – reduce risk of gastric cancer • what is optimal health? – Diet affects health! – Implications for all types of human research 17
18 What is another theoretical example of a nutrient and a criteria of adequacy that reflects chronic disease risk INSTEAD of deficiency disease risk? ⓘ Start presenting to display the poll results on this slide.
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Estimated Average Requirement (EAR) A daily nutrient intake value that is estimated to meet the requirement of HALF of the healthy individuals in a particular life stage and gender group 19
EAR: What is the point?? • amount that meets 50% of individuals in a particular life stage, gender group • used in nutrition policy • used for planning: – how much a GROUP needs • Used for assessment: – adequacy of nutrient intakes of an INDIVIDUAL – adequacy of nutrient intakes of a GROUP 20
Planning and Assessing Individuals and Groups 21 UL: can be used for all 4 scenarios
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Recommended Dietary Allowance (RDA) The average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97.5%) of healthy individuals in a particular life stage and gender group 22
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RDA: What does it mean? • EAR plus two standard deviations • Normal distribution – 68-95-97.5 % rule for normal distributions • used for planning for INDIVIDUALS – aim for the RDA • different from previous RDA/RNI in that different criteria of adequacy are used • intake over time • day to day variation expected 23
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Planning and Assessing Individuals and Groups 24 UL: can be used for all 4 scenarios
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Adequate Intake (AI) A recommended daily intake value based on observed or experimentally determined approximations of nutrient intake by a group (or groups) of healthy people - used when the EAR and RDA cannot be determined 25
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AI: What does it really mean?? • created when there isn’t enough evidence to calculate an EAR and subsequent RDA • obtained from data that show a mean intake that appears to sustain a desired indicator of health (eg. calcium retention in bone) • Used for planning: – for INDIVIDUALS, when a RDA does not exist – -for GROUP when EAR does not exist • Used for assessment: – For INDIVIDUALS, when an EAR does not exist – For GROUPS, when an EAR does not exist • has limitations, not as accurate as the EAR for assessment 26
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Planning and Assessing Individuals and Groups 27 UL: can be used for all 4 scenarios
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Tolerable Upper Intake Level (UL) The highest level of daily nutrient intake that is likely to pose no risk of adverse health effects to almost all individuals in the general population. As intake increases about the UL, the risk of adverse effects increases 28
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UL: What does it really mean??ended • guards against over-consumption • NOT a recommended level of intake • useful due to increased use of supplements and increased availability of fortified foods • based on total intake from food, fortified food and supplements • Can be used for planning and assessment 29
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Planning and Assessing Individuals and Groups 30 UL: can be used for all 4 scenarios
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(obtained from Health Canada website) Dietary Reference Intakes 31
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32 Dietary Reference Intakes
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DRIs vary by Life Stage Group • Specific values for life stage groups – Infants – Children – Males, females – Pregnancy, lactation • Various age cutoffs as well • Note that infants usually assigned an AI – where do you think they get the number from? 33
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DRIs: some comments • everyone is different! • values are set accounting for this variation • used for PLANNING and ASSESSMENT • note that people eat FOOD not NUTRIENTS – DRIs can be helpful as guidelines for individuals – Healthy eating is best planned using Canada’s Food Guide to Healthy Eating 34
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DRI: Review of the Issues • (1) estimates apply to healthy people • (2) estimates reflect usual daily intakes – Need to account for variability somehow • (3) each DRI reference number serves a unique purpose – EAR then RDA – AI is set when there is no EAR – UL • (4) all used in planning and assessments of groups or individuals • (5) subject to review as evidence evolves 35
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• “Given their importance to nutrition policy, the DRI values should be updated when significant, new, and relevant evidence is available.” • “Since the original DRI reports were published, the DRI values for vitamin D and calcium, as well as for sodium and potassium, were updated based on this criterion” 36
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37 • DRIs apply to HEALTHY individuals • Current work on redefining this application since a high number of North Americans have a chronic disease
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Implementation of DRIs in Canada • HC assembles expert advisory panels • Review DRIs and identify public health implications in Canada • Public policy • Public programs • Public education • Links between DRI and Canada’s Dietary Guidelines (Canada’s Food Guide, food labels, food fortification policy) 38
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Nutrients for Thought • DRIs are set for each single nutrient – What are the advantages of this? – Are there any disadvantages? • Note there are no DRIs for phytochemicals as they are not considered essential – However, this could change with advances in evidence about phytochemicals and health as well as the framework to consider chronic disease risk as a criteria of adequacy 39
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Planning and Assessing Individuals and Groups 40 UL: can be used for all 4 scenarios
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Which DRIs to Use? • You are a dietitian and you have a client in your office. You want to compare his individual intake of calcium to the DRIs. Which value should you use? • You are a nutrition supervisor at a nursing home. You are involved in planning the daily menus for all the residents. You know that you need to consider total daily nutrient intakes to set goals for the group. Which value do you use? 41
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