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Inclex A Acceptable Macronutrient Range, 30, 78, 80 Adequacy of nutrient intake. See also Prevalence of inadequate intakes assessment of, 95-96, 196; see also Dietary assessment confidence levels, 84, 94 criteria of, 23, 24, 28, 29, 30, 83, 102, 166 energy intake and, 31-32, 91 in group-level planning, 29, 75, 81, 83, 91, 95-96, 114, 115, 184, 185 in individual-level planning, 26, 37, 45- 47, 50, 53 observed difference and, 37 probability of correct conclusion about, 37, 81 quantitative assessments of, 37 risk-reduction based indicator of, 22, 23 uncertainty in, 29 Adequate Intakes (AIs). See also specific nutrients applicable population, 25 context for use, 4, 23, 39 Daily Values on food labels compared, 52 defined, 3, 24-25, 39 derivation of, 22-23, 25, 39, 83 213 EARs compared, 4, 25, 154 and food guides, 47, 49 in group-level planning, 9, 11-12, 83- 84, 85-87, 94-95, 103 and group mean intake, 83, 84, 85-87 in individual-level planning, 4, 6, 35, 37, 39, 41 menu planning with, 11-12, 83-84, 85- 87 and nutrient density approaches, 94, 103 nutrients, by life-stage group, 85-87 and prevalence of inadequate intakes, 84, 94 RDAs compared, 4, 25 replacement with EARs and RDAs, 25, 154 research recommendations, 25, 154 uncertainty in, 4, 39, 133-134 uses, 2, 4, 25 Adjusting intake distributions backtransformation of adjusted data, 166, 200-201, 203 defining groups for, 204 EAR and, 65-68 EAR cut-point method and, 10, 109, 201 energy, 33, 205 estimation of within- and between- person variance, 33, 63-64, 199-200, 204, 207-208

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214 incomplete data, 202-203 individual subjects' means, 200 Iowa State University method, 64, 109, 117, 196-197, 202, 203-204, 205, 206 limitations of methods, 205-206 macronutrient composition of diets and, 205 NRC method, 64, 109, 196, 197-203, 205, 206, 207-208 ratios, 184, 205 residual method of energy adjustment, 33 sample size and, 64, 197, 202-203, 204 SAS program, 198, 207-208 Shapiro-Wilk statistic, 198 SIDE package, 293 skewed data, 166-167, 184, 188, 201- 202 special considerations, 57, 201-203 systematic effects on within-person variation and, 33, 204 transformation of data, 198-199, 200- 201, 202, 203 underlying concepts and assumptions, 197-198, 205-206 underreporting of intakes and, 32-34, 206 weighting factors, 99, 101, 204 zinc example, 70, 198-201 Adolescent boys energy intakes, 185 vitamin A, 130, 131 vitamin C, 117, 119, 120, 122, 185, 187 Adolescent girls iron, 142 zinc, 10, 60, 62, 70, 95, 123-126 Adults over age 50, physiological changes affecting nutrient requirements, 64, 135, 143-144 Alcohol, 54, 80, 144, 178 Amino acids, indispensable, 137-138 Assisted-living setting, 56, 81, 83, 108-113 Asymmetrical distribution. See Skewed distribution Athletes, 36, 140-141 B B vitamins, 140 Basal metabolic rate, 31, 32 DIETARY REFERENCE INTAKES Basal requirement, defined, 28 Beta-carotene, 47, 152 Beta-carotene:retinol equivalency ratio, 48 Between-person variance, 63, 64, 75, 98- 99, 188 Bias. See also Error sources; Measurement error in cut-point method, 74, 75 in distribution of intakes, 74 in energy intakes, 33, 92, 105 in usual nutrient intakes, 92, 105 Bioavailability of nutrients, 15, 17, 29, 50, 134-135, 136, 137, 143-144, 145 Biotin, 52, 85 Body mass index, 24, 41, 105, 168, 169 Body weight. See Weight Boston Nutritional Status Survey, 110-111 C Calcium, 25, 39, 49, 52, 85, 135, 136, 194 Canada Consumer Packaging and Labeling Act, 178 Food and Drugs Act, 178 Food and Drugs Regulations, 178 Food Guide to Healthy Eating, 7, 12, 35, 44, 45, 46, 172, 173 Food Inspection Agency, 178 food labels, 51, 54, 177-179 fortification of foods, 50, 126, 192, 194 Guide to Food Labeling and Advertising, 177-178 Health Canada, 164 Nutrition Canada Survey, 168-169 Nutrition Recommendations, 35, 51, 53, 181-182 Vitality program, 173 Canadian National Institute of Nutrition, 164 Canadian Recommended Nutrient Intakes (RNIs), 2, 7, 19, 20, 21, 22, 44-45, 164, 178, 181 Carbohydrate. See also Macronutrient distribution Acceptable Macronutrient Range, 78 actual vs. recommended intakes, 49 usual energy intakes from, 78-79, 80 Carotenoids, 47, 48, 54 Child and Adult Care Feeding Program, 113

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INDEX Children, ages 1 through 8 years EER, 4 fortified foods, 50, 194 nutrition programs, 58, 90, 113-116 physiological considerations in planning for, 141 Choline, 25, 52, 85 Chromium, 52, 86, 176 Chronic disease risk reduction food health claims, 174, 178-179 as indicator of nutrient adequacy, 22, 164, 180 Cigarette smoking, 144 Coefficient of variation (CV) EAR and RDA, 24, 65 of nutrient requirement, 166, 184 Continuing Survey of Food Intakes by Individuals (CSFII), 40, 79, 109, 110-111, 114, 117, 128, 129, 138, 185 Copper, 49, 52, 86, 136, 184 Criterion of nutritional adequacy, 23, 24, 28, 29, 30, 83, 102, 166 Cut-point method accuracy, 71 and adjustment of intake distributions, 10, 109, 201 assumptions in, 59, 62, 73 bias in, 74, 75 correlated intakes and requirements and, 17, 41, 61, 75-76, 78 defined, 59 distribution of usual intakes, 57, 70, 72, 96-97 EAR and, 9-10, 17, 55, 59, 60, 61, 62, 68-73, 74-76, 94, 96-97, 109, 110- 111, 123, 154 prevalence of inadequate intakes, 9-10, 17, 55, 59, 60, 61, 62, 68-73, 75-76, 94, 96-97, 109, 110-111, 123, 154 probability approach compared, 17, 59, 73-76 requirement distribution and, 17, 59 requirement variance relative to intake variance, 59 Cysteine, 137, 138 D Daily Reference Values, 174-175 Daily Value (DV), 51, 52, 174, 175-176 215 Data and database issues. See also Adjusting intake distributions availability of usual intake data, 108- 109, 149 food composition databases, 7, 17, 27, 29, 30, 132, 151, 152, 206 quality of dietary intake data, 15-16, 17, 63, 150-152 research recommendations, 149, 150- 152 self reports of dietary intakes, 15-16, 27, 29, 30-34, 63, 64-65, 104, 151 supplement intakes, 151 uncertainty in nutrient requirements, 27, 29-30 Defined nutritional states, 83 Density estimation. See Nutrient density approaches; Nutrient density distribution approach; Simple nutrient density approach Dental caries, 192 Diet histories, 31, 37 Dietary assessment applications, 1, 20-21 dietary planning compared, 1, 20-21, 22, 27, 62 error sources, 64, 202 generalizability of results, 32-33 individual-level, 37 Dietary guidance systems, 44 Dietary guidelines, 2, 7, 35, 51, 53-54, 179- 182 Dietary (;uidelinesfor Americana, 35, 171, 180-181 Dietary intake data. See also Data and database issues; Dietary survey data; Measuring dietary intakes; Observed intakes; Usual nutrient intakes adjustment of, see Adjusting intake distributions collection, 31, 33, 99, 196, 205 error sources in, 29, 30-34, 37, 64, 70, 76, 196, 197 fortified foods, 129, 193-194 for group-level planning, 129 habitual intakes, 195 individual variations in, 16, 33, 63 quality of, 15-16, 17, 63, 149, 150-152, 153 research recommendations, 17, 149, 150-152, 153

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216 self reports, 15-16, 27, 29, 30-34, 63, 64-65, 104, 151 supplements, 17, 151 from surveys, 9, 10, 13, 34, 64, 84, 205- 206 uncertainty in estimates, 27, 30-34, 37 underreporting, 15-16, 17, 27, 29, 30- 34, 63, 64-65, 104, 206 Dietary planning. See also Group-level planning; Individual-level planning acceptably low probability of nutrient inadequacy and, 26-27 activities most relevant for, 2, 21 age and physiological considerations, 27, 140, 141-144, 167 bioavailability considerations, 15, 17, 29, 50, 134-135, 136, 137, 143-144, 145 body size or composition considerations, 140 caveats, 27-34, 108-109 choice of requirement criterion and, 28 context for applications in this report, 1, 20 data limitations and, 27 dietary assessment compared, 1, 20-21, 22, 27, 62 distribution of usual intakes and, 26 with EAR, 4, 6, 8, 9-10, 29-30, 37, 38, 60, 72, 96-97, 124 energy metabolism considerations, 140-141 error sources in, 29-34; see also Uncertainties genetic influences, 139-140 goals and goal setting, 3, 26, 30 hybrid approach, 58 implementation steps, 3, 5, 26-27 levels of, 1, 20 lifestyle factors affecting, 36, 144 nutrient density in, 90-91, 183-191 nutrient-nutrient interactions and. 135-136 nutritional status and, 28-29, 33, 133, 139, 145 research recommendations, 16-17, 57, 83, 88, 147-155 special considerations, 15-16, 36, 57, 133-146, 201-203 for subgroups, 13-14, 50, 53-54, 90, 97- 102, 107, 108-152 Dietary recalls, 31, 37, 63, 109 DIETARY REFERENCE INTAKES Dietary records, 31, 37, 63, 109 Dietary Reference Intakes (DRIs). See also Dietary planning adjustment for specific individuals and populations, 134, 139-140, 144-146, 154 age and, 25, 139, 141, 143-144 applicable population, 2, 22, 144 assessment applications, 1, 20-21, 22, 27, 32-33, 37, 62, 64 categories, 21, 37; see also adequate Intakes, Estimated Average Requirements; Recommended Dietary Allowances; Tolerable Upper Intake Levels criteria for, 2, 23, 28 data limitations, 27, 133 defined, 1, 2, 20, 22 describing dietary survey data with, 17 energy intake and, 30, 41, 140 extrapolation of data, 168-169 framework, 20-21, 22, 23, 164, 165-166 group-level planning with, 4, 21, 55-132 incorporation into food guidance systems, 35, 36, 44-45, 47-49, 171 individual-level planning with, 4, 6, 21, 35-54 origin, 163-164 parameters for, 167-168; see also Life stage group; Reference heights and weights physiological considerations, 140, 141- 144 processes used to establish, 22-23 prorating across meals, 115-116 RDAs and RNIs contrasted, 2, 19, 22, 24,47-48, 113, 164 uses, 2, 20-21, 37; see also Dietary assessment; Dietary planning Dietary reference standards, 44-45, 56 Dietary survey data adjusting intake distributions, 10 describing, 17 distribution of usual intakes from, 9, 10, 13, 33-34, 64, 70, 84, 109, 110- 111, 123, 203-204, 205-206 fortification of foods and, 132 Distribution of observed intakes in group-level planning, 63-64, 78, 112, 196-208 statistical adjustment technique, 26, 196, 203-204

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INDEX systematic effects on, 203 usual intake distribution estimated from, 26, 63-64, 196-208 variance of, 199 Distribution of requirements. See alsoJoint distribution; Nutrient requirements AIs and, 103 and cut-point method, 17, 59 EAR and, 166-167 factorial modeling, 166-167 iron, 10, 24 Monte Carlo simulation, 167 normal/symmetrical, 23, 24, 27, 73, 184, 201-202 physiological considerations and, 140, 167 and probability approach, 17, 73-74 protein, 166, 184 skewed/asymmetrical, 10, 23, 24, 69- 70, 73-74, 94, 80, 105, 166-168, 184 standard deviation of, 24, 166-167 for subgroups, 166, 184 and target usual nutrient intake distribution, 73-74, 80 variance of, 24, 59, 62, 74-75, 140 Distribution of usual intakes. See also Adjusting intake distributions; Skewed distribution; Target nutrient density distribution; Target usual nutrient intake distribution baseline, 57, 59-60, 61, 62, 63-65, 99, 110-111, 112 characteristics of, 71 defined, 26 from distribution of observed intakes, 26, 63-64, 196-208 EAR cut-point method and, 57, 70, 72, 96-97 fortification of foods and, 127, 128-129 for group-level planning, 27, 28, 55-56, 57, 59-60, 61, 63-65, 74, 76, 83, 87- 88, 97, 98, 110-111, 196-208 interventions to change, 16, 57, 60, 72, 87-88, 107, 108, 123-132, 148-149 for macronutrients, 205 median of, 65, 78, 110, 111, 124 as nutrient density, 98, 184-185, 190-191 from one day of intake data, 26, 47, 196, 200, 203, 205 and prevalence of inadequate intakes, 10, 28, 57, 58-59 217 probability approach and, 17, 74 skewed, 69-70, 166-167, 184, 188, 201- 202 software for estimating, 82 stable, 71 in subpopulations, 90, 91-92, 94, 97, 107, 109, 110-111, 112, 115, 117, 184 supplement use and, 123-124, 125-126 from survey data, 9, 10, 13, 33-34, 64, 70, 84, 109, 110-111, 123, 203-204, 205-206 variance of, 9, 26, 33, 58, 59, 62, 63, 64, 67, 68, 71, 72, 74-75, 83, 92, 98- 99, 109, 188, 197, 199-200, 207-208 Doubly labeled water method, 31, 41, 104 E Education. See Nutrition education EER (estimated energy requirement) average, for group members, 76, 77-78 for body weight maintenance, 43 calculation for reference person, 12, 76-77 defined, 4, 6 derivation of, 23-24, 41-42, 105 for heterogeneous groups, 14, 76, 77 for homogeneous groups, 9 for individuals, 4, 41-43 physical activity coefficient, 42, 77 standard deviation, 41-42 uses, 6 Elderly people. See Adults over age 50 Emergency food rations, 81, 148, 150, 183- 191 End-stage renal disease, 145-146 Energy expenditures defined, 76 doubly labeled water method, 31, 41, 104 energy intakes and, 33, 42, 75-76, 105 error in reporting, 92-93, 104-106 factorial methods, 31, 33 total (TEE), 24, 41, 43, 76, 105 Energy intakes and adequacy of nutrient intakes, 31- 32, 91 adjustment of, 33, 205 athletes, 36, 141 averaging, 98-99, 100-101

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218 between-person variance, 98-99 bias related to, 33, 92, 105 comparison of target median nutrient intake to mean, 93-96, 118-119, 185 correlation between energy expenditures and, 33, 42, 75-76, 105 correlation between energy requirement, 41, 76, 78, 105, 140 correlation between nutrient intakes and, 98-102, 103-104 and DRIB, 30, 41, 140 and energy expenditures, 33, 42, 75- 76, 77, 105 error sources, 12, 15, 30-34, 76, 92-93, 104-106 from fat, 9, 31, 32, 79-80, 205 group-level planning, 9, 12, 64-65, 72, 75-78, 89, 91-92, 93-96, 98-99, 118- 119, 183, 185-186 individual-level planning, 4, 6, 31, 41- 43, 49, 54 iron intakes and, 90 joint nutrient intake and, 31-32, 98- 102, 103-104, 188 macronutrient distribution of, 6, 9, 30, 43, 78-80, 205 mean of distribution as target, 12, 13, 75-76, 84, 92, 93-96 and nutrient density distribution approach, 91-92, 97, 100-101, 103- 104 prevalence of inadequate intakes, 78- 80 self-reports, 12, 15, 30-34, 76, 93, 104- 106, 151 simple nutrient density approach and, 89, 91, 93-96, 118-120 target usual nutrient intakes combined with, 96, 97-98, 105 underestimation, 31-32, 64-65 underreporting, 12, 15, 30-34, 76, 93, 104-106, 151 weight as measure of, 41 within-person variability, 31, 33, 41-42, 91-92 within-subgroup variability, 89, 90, 91- 92, 95-96, 97, 98-99, 117 Energy requirement. See also EER body size and, 140 defined, 76 DIETARY REFERENCE INTAKES derivation of, 24 energy intake correlation, 41, 76, 78, 84, 105, 140 mean, 89, 91, 93-96, 118-120 simple nutrient density approach and, 89, 91, 93-96, 118-120 Error sources. See also Measurement error in dietary assessments, 64, 202 in dietary intake estimates, 29, 30-34, 37, 64, 70, 76, 196, 197 in energy intake data, 12, 15, 30-34, 76, 92-93, 104-106 in group-level planning, 30, 71 in individual-level planning, 37 in nutrient density approaches, 92-93, 104-106 in requirement estimates, 29-30, 105 research needs, 106 weight and height reports, 93, 106 Estimated Average Requirements (EARs) AIs compared, 4, 25, 154 criteria of adequacy, 23, 28, 29, 30 cut-point method, 9-10, 17, 55, 59, 60, 61, 62, 68-73, 74-76, 94, 96-97, 109, 110-111, 154 CV, 24, 65 defined, 3, 23-24 derivation of, 22-24, 28 dietary intake distribution adjustments, 65-68 endpoints, 28 and fortification of foods, 127 in group-level planning, 55-56, 59, 60, 65-68, 76 in individual-level planning, 8, 37, 38 by nutrient and life-stage group, 10 nutrient density approach and, 96-97 planning intakes with, 4, 6, 8, 9-10, 29- 30, 37, 38, 60, 72, 96-97, 124 rationale for term, 23 and RDA, 23, 24, 28, 62, 133 research recommendations, 17, 153- 154 risk of inadequacy, 22, 23 skewed distribution of requirements and, 166-167 standard deviation of intake for individual, 62, 65 uncertainty in, 27, 29-30, 133 uses, 2, 4, 127 variability related to, 133

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INDEX Examples of planning for groups assisted-living facility for seniors, l 08-113 for heterogeneous groups, 116-123 school nutrition program, 113-116 Excessive intakes of nutrients, 6, 35, 40-41, 50-51. See also Prevalence of excess intakes; Risk; Tolerable Upper Intake Levels Extrapolation of data, 27, 168-169 F Factorial modeling, 31, 33, 166-167 Fat, dietary Acceptable Macronutrient Range, 30, 78, 80 dietary guidelines, 54 energy intakes from,9,31, 32, 79-80,205 nutrient content claims, 176 nutrient interactions, 136 underreporting of intakes, 30, 31 Fiber, dietary, 85 Fluoride, 52, 85, 192 Folate, 28, 47, 49, 50, 52, 54, 86, 127, 134, 135, 140, 142, 144, 152, 153, 193, 194, 195 Folic acid, 50 Food and Agriculture Organization/ World Health Organization, 28 Food and DrugAdministration,51,173, 174 Food assistance programs, 2, 56-57, 58, 81, 88, 113-116 Food composition data, 7, 17, 27, 29, 30, 44, 64, 132, 134, 151, 152, 194-195, 206 Food frequency questionnaires, 31, 37, 63 Food Guide for the Northwest Territories, 172 Food Guide Pyramid, 7, 12, 35, 44, 45, 47, 48, 49, 82, 171-173, 180 Food guides, 7, 12, 17, 35, 45-49, 81, 82, 152, 153, 171-173 Food labels. See Nutrition labels and labeling Food offerings and group-level planning, 12, 72, 81, 82-83, 112-113 menu planning, 12, 72, 81, 82-83, 112- 113 and nutrient intakes, 16, 81, 82-83, 84, 149 research needs on, 149 219 Food preferences, 13, 20, 84 Food Stamp Program, 56-57, 58, 90, 113 Food waste, 12, 82 Fortification of foods, 2 benefits of, 49-50 bioavailability of nutrients, 134, 135 in Canada, 50, 126, 192, 194 detrimental effects, 126-127, 130-131 in developing countries, 192 and distribution of usual nutrient intakes, 127, 128-129 EAR and, 127 and food composition databases, 132, 152, 194-195 group-level planning, 87-88, 126-132 impact on intakes, 129, 193-194 individual-level planning, 7, 36, 40-41, 49-50, 136 interactions of nutrients and, 136 mandatory programs, 50, 127, 132, 148, 192, 194 market pressures, 193 modeling and estimating effects of, 127-132, 193 nutrition labeling and, 193, 195 and prevalence of excess intakes, 130- 131 and prevalence of inadequate intakes, 129-130, 132 regulation, 50, 194 supplement availability and use and, 195 and survey data, 132 targeting, 126, 193 technology for, 192-193 and ULs, 25, 40, 127, 130-131, 136, 152, 195 in United States, 50, 126, 192-195 Vitamin A added to milk, 127-132 voluntary, 50, 126, 127, 132, 148, 192 G Group-level planning. See also Examples of planning for groups; Heterogeneous groups; Homogeneous groups; Subgroups/ subpopulations adequacy of nutrient intakes in, 29, 75, 81, 83, 91, 95-96, 114, 115 AIs in, 9, 11-12, 83-84, 85-87, 94-95, 103

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220 DIETARY REFERENCE INTAKES analytic issues, 114-116 assessment of plan results, 13, 16, 56, 57, 78, 83, 84, 87, 95-96, 109, 113, 120 CV in, 75, 184, 185 decision tree for, 106 distribution of observed intakes in, 63- 64, 78, 112, 196-208 distribution of usual intakes for, 27, 28, 55-56, 57, 59-60, 61, 63-65, 74, 76, 83, 87-88, 97, 98, 110-111, 196- 208 EARs and, 55-56, 59, 60, 65-68, 76 energy intakes, 9, 12, 64-65, 72, 75-78, 89, 92, 93-96, 98-99, 118-119, 183, 185-186 energy requirements, 76, 77-78 error sources, 30, 71 food guides and, 17 food offerings, 12, 72, 81, 82-83, 112-113 fortified foods and, 87-88, 126-132 general considerations, 56-58 goals and goal setting, 3, 8-9, 11-12, 13, 26, 28, 30, 55, 56-57, 61-62, 81-82, 84, 95, 96, 99, 102-103; see also Nutrient density approaches; Target usual nutrient intake distribution hybrid approach, 58 implementation steps, 7, 8, 16-17, 56, 60 interventions to change intake distribution, 57, 60, 72, 87-88, 123- 132 macronutrient distribution, 78-80 menu planning, 11-13, 15, 61, 72, 80- 87, 112-113, 116 methods, 1, 55, 59-76 overview, 58-63 pilot testing approaches to, 16, 147-148 prevalence of excessive intakes and, 8, 55-56, 59, 87-88 prevalence of inadequate intakes and, 8, 27, 28, 57, 58-59, 60, 65-68, 74- 75, 87-88, 94, 99, 110, 114-115, 117- 118, 123, 185 quantities of foods, 12 RDAs and, 4, 21, 26-27, 55, 62, 65-68, 113, 114, 116 research implications and recommendations, 16-17, 57, 147- 150 sample size considerations, 64, 71 supplements and, 123-126 ULs and, 8, 10-11, 55-56, 59, 60, 92, 119, 120 underlying principle, 58-59 uses of DRIs for, 4, 21, 114 Group mean intakes, 83, 84, 85-87, 200 H Handbook for Canada's Physical Activity Guide to Healthy Active Living, 173 Health Canada, 164 Health claims, 174, 178-179 Heterogeneous groups average nutrient requirement approach, 90 comparison of target median nutrient intake to mean energy intake, 93-96 EER, 14, 76, 77 energy intake variability, 89, 91-92 examples of planning for, 116-123 goals and goal setting, 96, 99, 102-103 menu planning for, 116 nutrient density approaches, 13-15, 16- 17, 96-103, 183-191 target usual nutrient intake distribution for, 90, 94-95, 96-97 Homogeneous groups dietary planning for, 8-13, 108-113 EER for, 9 energy intakes, 72, 76-78 examples of planning for, 108-116 food offerings, 12, 82 goals and goal setting, 8-9, 11-12, 56, 65-68, 81-82, 110-111; see also Target usual nutrient intake distribution interventions to change intake distribution, 57, 87-88, 107, 108, 148-149 macronutrient distribution, 78-80 menu planning, 11-12, 72, 80-87, 112- 113, 116 quantities of foods to purchase, offer and serve, 12, 82-83 reference person, 76-77 target usual nutrient intake distribution for, 9-11, 26, 55, 59-76, 110-111, 114-115 Hospital patients, 58, 145 Human milk, 25, 143

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INDEX Ill people, 36, 58, 139, 144-146 Inadequacy of nutrient intake. See Prevalence of inadequate intakes Indicators of nutrient adequacy, risk reduction-based, 22, 23 Individual-level planning adequacy of nutrient intakes in, 26, 37, 45-47, 50, 53 AIs and, 4, 6, 35, 37, 39, 41 development of plans, 1, 4, 7, 35-36, 43-54 dietary guidelines and, 51, 53-54 dietary intake assessments and, 37 EAR and, 8, 37, 38 EER and, 4, 41-43 for energy intakes, 4, 6, 31, 41-43, 49, 54 error sources, 37 food guides and, 7, 35, 45-49, 172-173 food labels and, 51 fortified foods and, 7, 36, 40-41, 49-50, 136 goals and goal setting, 3, 4-6, 7, 35, 36-41 ill people, 36, 58, 139, 144-146 implementation steps, 4-7, 36-37 for macronutrient distribution, 43, 44, 51, 53 menu planning, 47, 48, 49 for normal healthy individuals, 36-54 nutrient-based food guidance systems and, 7, 35, 43, 44-49, 51, 53-54, 172- 173 RDAs and, 4, 6, 21, 26, 35, 37-39, 41, 134, 138-139 supplements and, 7, 35, 50-51 ULs and, 4, 6, 35, 37, 39-41 uses of DRIs for, 4, 6, 21, 35-54 Infants AI derivation for, 25 fortified foods, 50 Institutional food planning, 2, 56, 58, 64, 72, 75, 81, 90, 108-113, 145 Iodine, 50, 52, 87, 126, 184, 192 Iodine deficiency diseases, 192 Iowa State University method, 64, 109, 117, 196-197, 202, 203-204, 205, 206 Iron, 10, 15, 24, 28, 38-39, 49, 50, 52, 73, 74, 87, 90, 94, 97, 102, 135-137, 139, 141, 142, 166, 167, 184, 188, 190, 192, 194, 195 221 J Joint distribution of intakes and requirements, 75-76, 103, 104, 167, 188 of nutrient and energy intakes, 31-32, 98-102, 103-104, 188 Joint Food and Agriculture Organization/ World Health Organization Expert Consultation, 28 L Labels. See Nutrition labels and labeling Life stage group AIs for nutrients by, 85-87 categories, 167-168 and derivation of DRIB, 167-168 food guidance by, 172 Lifestyle factors, 36, 144 Likelihood of adequacy, 65, 91 of excessive intakes, 120 Lipoprotein lipase deficiency, 139 Long-term care facilities, 64 Lowest-observed-adverse-effect level (LOAEL), 23 Lysine, 137-138 M Macronutrient distribution adjustment of intake data, 33, 205 DRVs, 174-175 of energy intake, 6, 9, 30, 43, 78-80, 205 for heterogeneous groups, 78-80 for homogeneous groups, 78-80 individual-level planning for, 43, 44, 51, 53 Magnesium, 49, 52, 85, 135, 141 Manganese, 87 Mean intake, 12, 13, 75-76, 84, 89, 91, 92, 93-96, 97, 118-119, 200 Mean requirement, 89, 90, 91, 93-96, 118- 120 Measurement error in energy intake and energy expenditure, 92-93, 104-106 in estimated prevalence of inadequacy, 64-65, 76, 104-106

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222 DIETARY REFERENCE INTAKES in nutrient intakes, 15-16, 29, 30-34, 37, 70, 196, 197 in physiological parameters, 92-93, 106 in self-reported data, 106 Measuring dietary intakes observational, 15-16, 109, 197 self-reports, 15-16, 27, 29, 30-34, 63, 64- 65, 76, 93, 104-106, 151 Men EER, 76-77 serving size, 195 vitamin C, 117, 119, 120-121, 122 Menu planning with AIs, 11-12, 83-84, 85-87 assessment of results, 84, 87 contexts, 81 food offerings, 12, 72, 81, 82-83, 112- 113 goals, 11-12, 81-82 for groups, 11-13, 15, 61, 72, 80-87, 112-113, 116 for individuals, 47, 48, 49 quantities of foods, 12, 82-83 research needs, 83, 153 steps, 81-87 Methionine, 137, 138 Molybdenum, 87, 184 Monte Carlo simulation, 167 N National Health and Nutrition Examination Survey Fourth, 151 Third, 10, 28-29, 30, 60, 70, 74, 109, 110-111, 114, 123, 151, 168, 169, 170 National Nutrition Monitoring and Related Research Act, 180 National Research Council, 64, 109. See also NRC method of adjustment National School Lunch Program, 113, 149, 153 Neural tube defects, 135, 141-142 Niacin, 49, 50, 52, 86, 135, 140, 144, 184, 192 Night blindness, 28, 128, 129 No-observed-adverse-effect level (NOAEL), 23 Nonnormal distribution. See Skewed distribution Normal distribution of intakes, 57, 59-60, 61, 62, 65-66, 68- 71, 80, 99, 110-111, 112, 198-199 of requirements, 23, 24, 27, 73, 184, 201-202 and target usual nutrient intake distribution, 57, 59-60, 61, 62, 63- 65, 110-111, 112 Normative storage requirement level, 28 NRC method of adjustment, 64, 109, 196, 197-203, 205, 206, 207-208 Nutrient-based food guidance systems. See also Food guides in group-level planning, 17 incorporation of DRIs in, 35, 36, 44-45, 47-49, 171 and individual-level planning, 7, 35, 43, 44-49, 51, 53-54, 172-173 research recommendations, 17, 152-153 technical tools for professionals, 153 United States, 7, 12, 35, 44, 45, 47, 48, 49, 51, 53, 82, 171-173, 180-181 Nutrient calculation software, 12, 82 Nutrient content claims, 174, 176-177, 178-179 Nutrient content of food, 11 Nutrient density average intake, 98-99, 121 calculation of usual intake distribution as, 98, 184-185, 190-191 defined, 13, 91, 98 reference (median intake) distribution, 96, 102-103, 119, 187-188 use in dietary planning, 90-91, 183-191 Nutrient density approaches. See also Nutrient density distribution approach; Simple nutrient density approach comparison of, 122-123 for heterogeneous groups, 13-15, 16- 17, 96-103, 183-191 mathematical proof, 188-191 and prevalence of inadequate intakes, 94, 96-97, 99, 102, 185-187 research recommendations, 16-17, 149- 150 Nutrient density distribution approach AIs and, 103 correlation between nutrient intakes and energy intakes, 98-102, 103- 104, 122

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INDEX derivation of target usual density intake distribution, 14-15, 96, 97- 102, 121-122, 184-185 direct interventions used with, 102-103 effectiveness, 103 energy intakes and, 91-92, 97, 100-101, 103-104 error sources, 104-106 example, 120-123 identifying reference distribution and setting goals, 102-103, 119-120 strengths of, 102-103 target usual nutrient intake distribution and, 14-15, 16-17, 92, 96-97, 99-100, 103, 104-105, 117- 118, 120-121 technical considerations, 103-106 ULs and, 96, 102, 119, 187 underreporting of energy intakes and, 104-106 Nutrient intakes. See Observed intakes; Usual nutrient intakes Nutrient-nutrient interactions, 135-136 Nutrient requirements, See also Distribution of requirements; Energy requirement; Estimated Average Requirements average/mean, 90, 166-167 correlated with usual intakes, 17, 41, 61, 75-76, 78 criterion of nutritional adequacy, 28 CV, 166, 184 error sources in estimates, 29-30, 105 physiological considerations, 140-144 research recommended, 17, 153-156 special considerations, 139-144 uncertainties for individuals, 27, 29-30, 38 variance of, 59, 139-144, 166 Nutrition Canada Survey, 168-169 Nutrition education, 15, 35, 44, 87-88, 95, 125, 148, 152-153 Nutrition Labeling and Education Act, 174 Nutrition labels and labeling, 2, 7 Canadian, 51, 54, 177-179 components, 176, 179 Daily Values Reference Daily Intakes, 51, 52, 174, 175-176, 179 development of, 173-175, 177-178 fortification of foods and, 193, 195 and individual-level planning, 51 223 nutrient content claims, 174, 176-177, 178-179 RDAs and AIs compared to DVs on, 52 research recommendations, 153 supplements, 17 United States, 51, 53, 173-175, 176-177 usefulness in planning, 35 Nutritional status, and dietary planning, 28-29, 30, 33, 133, 139, 145 Nutrition surveys. See Dietary survey data; individual surveys o Observed intakes. See also Distribution of observed intakes and individual-level planning, 37 mean intakes, 39, 83 probability of inadequacy or excess, 37 short-term, 37 Oral contraceptives, 142 p Pantothenic acid, 25, 52, 86 Parenteral nutrition, 145 Pellagra, 192 Phenylketonuria, 139 Phosphorus, 49, 52, 85, 141, 146 Physical activity, 24, 31, 32, 42, 77, 93, 105, 106, 140-141 Physiological consideration, 27, 92-93, 106, 140, 141-144, 167 Phytic acid, 136 Phytochemicals, 54 Plasma pyridoxal phosphate levels, 29, 110 Polyunsaturated fatty acids, 43, 78, 85 Pregnant and lactating women EER, 4 gestation of multiple fetuses, 142-143 menu planning, 47, 48, 49 supplement use, 50, 141-142 Prevalence of excess intakes estimation, 9, 10-11 fortification of foods and, 130-131 group-level planning and, 8, 55-56, 59, 87-88 skewed data and, 201-202 zinc, 10-11

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224 Prevalence of inadequate intakes AIs and, 84, 94 bias in, 64-65, 76, 104-106 distribution of usual intakes and, 10, 28, 57, 58-59, 87-88, 196 EAR cut-point method, 9-10, 17, 55, 59, 60, 61, 62, 68-73, 75-76, 94, 96- 97, 109, 110-111, 123, 154 energy, 78-80 estimation, 9-10, 11-12, 26-27, 55, 59, 71 fortification of foods and, 129-130, 132 in group-level planning, 8, 27, 28, 57, 58-59, 60, 61, 65-68, 74-75, 87-88, 94, 99, 110, 114-115, 117-118, 123, 185 iron, 10 low individual vs. low group risk, 65-68 median intake equal to RDA, 65-68 nutrient density approach and, 94, 96- 97, 99, 102, 185-187 and nutritional status, 28-29, 30 overestimation, 64-65 probability approach to estimating, 17, 59, 65, 73-76, 94, 97, 154 research recommendations, 17, 154 skewed data and, 87-88, 201-202 standard deviation of estimates, 166-167 statistical approaches, 64, 109, 117, 167, 196-204, 205, 206, 207-208 in subpopulations, 117, 123, 187 and target usual nutrient intake distribution, 57, 59, 60, 61, 65-68, 71, 73, 110, 114-115 uncertainty in, 71 underestimation of intakes and, 64-65 zinc, 10 Probability approach cut-point method compared, 17, 59, 73-76 and distribution of nutrient requirements, 17, 73-74 and distribution of usual intakes, 17, 74 prevalence of inadequacy from, 17, 59, 65, 73-76, 94, 97, 154 Professional development and education, 17, 152-153 Protein, dietary Acceptable Macronutrient Range, 78 food sources, 47 intake, 31-32, 43, 49. See also Macronutrient distribution DIETARY REFERENCE INTAKES percent of total energy intake, 78-80 physical activity and, 140 requirement distribution, 166, 184 vegan diets, 137-138 Provitamin A carotenoids, 47, 48, 152 R Recommended Dietary Allowances (RDAs) AIs compared, 4, 25 applicable population, 2, 22 context for use, 37-39 CV, 24 Daily Values on food labels compared, 52 defined, 3, 24 derivation, 23, 24, 28 and EAR, 23, 24, 28, 62, 133 and food and nutrition assistance programs, 113, 114, 116 and food guides, 44-45, 47-49, 171, 172 and food labeling and nutritional marketing, 52 group-level planning with, 4, 21, 26-27, 55, 62, 65-68, 113, 114, 116 inappropriate use of, 21, 22, 41 individual-level planning with, 4, 6, 21, 26, 35, 37-39, 41, 134, 138-139 and median target usual nutrient intake distribution, 62, 65-66 replacement with DRIB, 2, 19, 22, 24, 47-48, 113, 164 research recommendations, 153-154 risk of inadequacy, 38 target usual nutrient intake distribution and, 62, 65-68 uses, 4, 7, 20, 24, 44-45, 164 Reference Amounts Customarily Consumed Per Eating Occasion, 176 Reference Daily Intakes (RDIs), 51, 174, 175-176 Reference heights and weights and, 168-170 Reference (median intake) distribution, 96, 102-103, 119-120, 187-188 Reference person EER calculation for, 12, 76-77 in homogeneous groups, 76-77 in subgroups, 95, 102, 109, 119-120, 121-122, 187

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INDEX Research recommendations group-level planning, 16-17,57, 147-150 improving requirement data, 17, 153- 156 nutrient-based food guidance systems, 17, 152-153 quality of dietary intake data, 17, 149, 150-152, 153 Residual method of energy adjustment, 33 Retinol activity equivalents, 47-48, 115 Retinol equivalents, 48 Riboflavin, 49, 50, 52, 86, 140, 142 Richard B. Russell National School Lunch Act, 113 Rickets, 139, 194 Risk of excess, 6, 22, 39-40, 50-51, 135, 136 of inadequacy, 6, 22, 23, 30, 38, 65-68, 102, 145 Risk curve, 155 Risk-reduction indicator of nutrient adequacy, 22, 23 S Salt, 54 Sample size considerations, 64, 71, 197, 202-203, 204 School Breakfast Program, 113 School nutrition program, 90, 113-116 Selenium, 52, 85, 135 Self-reported data accuracy of, 15-16, 27, 29, 30-34, 63, 64-65, 104, 151 alternatives to, 105-106 energy intakes, 12, 15, 30-34, 76, 93, 104-106, 151 measurement error in, 106 nutrient intakes, 15-16, 29, 30-34, 64 weight and height, 93, 106 Senate Select Committee on Nutrition and Human Needs, 171, 180 Sensory neuropathy, 40 Serum alpha-tocopherol, 30 Serum ferritin, 139 Serving sizes, 45, 47, 116, 176, 195 Shapiro-Wilk statistic, 198 SIDE package, 293 Simple nutrient density approach accuracy, 93-94 AIs and, 94, 103 225 assessment of results, 92, 120 comparison of target median nutrient intake and energy intake, 94, 95, 119-120, 184-185 derivation of nutrient density distribution, 184-185, 190-191 and EARs, 96-97 error sources, 92-93, 104 example, 117-120, 122-123 and mean energy intake or requirement, 89, 91, 93-96, 118-120 median of target nutrient intake distribution and, 14, 89, 91, 93-96, 103, 117-118, 119-120 multiple-food basis, 91 single-food basis, 91, 183-191 and ULs, 92, 95, 96, 187 Skewed distribution adjusting, 166-167, 184, 188, 198-199, 201-202 of intakes, 69-70, 84, 166-167, 184, 188, 201-202 of iron, 10, 73, 94, 166, 184, 188 of nutrient requirements, 10, 23, 24, 69-70, 73-74, 94, 80, 105, 166-168, 184 and prevalence of inadequacy or excess, 87-88, 201-202 of protein, 184 and target usual nutrient intake distribution, 69-70, 80, 84, 94 transformation of, 166, 198-199, 200- 201, 202, 203 Sodium, 146 Special considerations adjusting intake distributions for, 57, 201-203 illness, 144-146 individual characteristics that influence requirements, 139-144 lifestyle factors, 36, 144 source of nutrient, 134-139 in supplement use, 136, 142, 143, 144, 173 Standard deviation of distribution of requirements, 24, 166-167 EAR and, 24, 62, 85, 166 EER, 41-42 of intakes, 24, 62, 65, 67-68, 69, 71, 72, 166

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226 in prevalence estimates, 166-167 Z values, 69 Statistical Analysis System (SAS) programs, 185, 186, 190-191, 198, 207-208 Statistical approaches, 64, 109, 117, 167, 196-204, 205, 206, 207-208 Subgroups/subpopulations. See also Heterogeneous groups; Homogeneous groups; Special considerations adjustment of DRIs for, 134, 139-140, 144-146, 154 direct interventions, 15,50, 102,126-132 distribution of usual intakes in, 90, 91- 92, 94, 97, 107, 109, 110-111, 112, 115, 117, 184 energy intake variability within, 89, 90, 91-92, 95-96, 97, 98-99, 117 planning intakes for, 13-14, 50, 53-54, 90, 97-102, 107, 108-152 prevalence of inadequacy in, 117, 123, 187 reference intakes, 95, 102, 109, 119- 120, 121-122, 187 skewed requirements, 166, 184 statistical adjustment of intake data, 204 and target usual nutrient intake distribution, 13-14 variability within, 89, 95-96, 97, 98-99 vegetarians, 36, 136-139 vulnerable, 13-14, 15, 50, 89, 91, 95 Summer Food Service Program, 113 Supplement use bioavailability of nutrients, 134, 135 disadvantages, 50 and distribution of usual intakes, 123- 124, 125-126 and fortification of foods, 195 in group-level planning, 123-126 high-dose/ high-potency, 40-4 1 individual-level planning, 7, 35, 50-51 interactions, 136 labeling, 17 pregnancy and lactation and, 142 quantifying intakes from, 17, 151 research recommendations, 17, 151 special considerations in, 136, 142, 143, 144, 173 targeted, 15, 36, 95, 143 and ULs, 120 DIETARY REFERENCE INTAKES Supplemental Nutrition Program for Women, Infants, and Children, 113, 149 Surveys. See Dietary survey data; individual surveys T Target nutrient density distribution. See also Nutrient density distribution approach derivation, 14-15, 96-102, 103, 121-122, 184-185 percentile method, 185, 187-188 and ULs, 102 Target usual nutrient intake distribution asymmetric requirement distribution and, 73-74, 80 baseline usual nutrient intake distribution and, 57, 59-60, 61, 62, 63-65, 110-111, 112 bias in, 74 . ~ .. . . . comparison 01 mecllan nutrient Intake to mean energy intake, 91, 93-96, 97 concept, 59-60 considerations in planning, 63-76 energy intakes and, 12, 13, 78-80, 84, 93-96, 118-119, 185 feasibility of obtaining, 71-73 for heterogeneous groups, 90, 94-95, 96-97 for homogeneous groups, 9-11, 26, 55, 59-76, 110-111, 114-115 median of, 10-11, 13, 14-15, 61-63, 65- 68, 69, 79-80, 81-83, 89, 91, 93-96, 109, 112-113, 114-115, 117-118, 119- 120 menu planning to achieve, 11-13, 61, 80-87, 112-113 normal distribution of usual intake and, 68-69 nutrient density approaches and, 14- 15, 16-17, 91, 92, 93-97, 99-100, 103, 104-105, 117-118, 120-121 prorating across meals, 115-116 RDA and, 62, 65-68 research recommendations, 149 skewed distribution of usual intake and, 69-70, 80, 84, 94

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INDEX stable distribution of usual intakes and, 71 target prevalence of inadequacy and, 57,59,60,61,65-68,71,73, 110, 114-115 usual energy intakes combined with, 96, 97-98, 105 vulnerable subgroup and, 13-14 Z value, 69 Thiamin, 49, 50, 52, 86, 140, 144, 194 Threonine, 137, 138 Tolerable Upper Intake Levels (ULs) i bioavailability considerations, 135, 136 context for use, 39-41 critical adverse effect, 22 defined, 3, 25, 39 derivation of, 25-26 dose-response assessment, 155 and food labels, 153 fortification of foods and, 25, 40, 127, 130-131, 136, 152, 195 n group-level planning, 8, 10-11, 55- 56, 59, 60, 92, 119, 120 in individual-level planning with, 4, 6, 35, 37, 39-41 LOAEL/NOAEL, 23 nutrient density approach and, 92, 95, 96, 102, 119, 120, 187 rationale for term, 25 research recommendations, 153, 154- 155 risk assessment approach, 25 supplement use and, 25, 40 uncertainty levels, 23, 134 uses, 2, 4 Total energy expenditure (TEE), 24, 41, 43, 76, 105 Tryptophan, 137, 138 U Uncertainties in adequacy of nutrient intakes, 29 in AIs, 4, 39, 133-134 in dietary intake estimates, 27, 30-34, 37 in EAR, 27, 29-30, 133 . . . ~ In nutrient requirements tor individuals, 27, 29-30, 38 in prevalence of inadequate intakes, 71 in ULs, 23, 134 227 United States Department of Agriculture, 113-114, 134, 171, 180, 203 Department of Health and Human Services, 180 Dietary Goals (1977), 171 dietary guidelines, 35, 51, 53, 180-181 Food Guide Pyramid, 7, 12, 35, 44, 45, 47, 48, 49, 82, 171-173, 180 food labels, 51, 53, 173-175, 176-177 fortification of foods, 50, 126, 192-195 Urinary nitrogen excretion, 31-32 US RDA, 51, 173-174, 175 Usual nutrient intakes. See also Dietary intake data; Target usual nutrient intake distribution assessment, 63 availability of data, 108-109, 149 baseline distribution, 57, 59-60, 61, 62, 63-65 between-person variance, 63, 64, 75, 188 correlation between usual energy intakes and, 98-102, 103-104 correlation of requirements and, 17, 41, 61, 75-76, 78 data sources, 9, 108-109, 114 defined, 6, 26 errors in, 15-16, 29, 30-34, 37, 70, 196, 197 food choices and, 16, 81, 82-83, 84, 149 joint energy intake and, 104 measurement of, 15-16, 27, 29, 30-34, 63, 64-65, 76, 93, 104-106, 109, 151, 197 nutrient content of food and, 11 observed vs. true, 63 self-reports, 15-16, 29, 30-34, 64 short-term intakes and, 26, 29, 47, 196, 200, 203, 205 within-person (day-to-day) variance, 9, 26, 63, 64, 92, 109, 197, 198, 199 V Variance. See also Between-person variance; Within-person variance in intakes EAR-related, 133

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228 it in intake distributions, 9, 26, 33, 58, 59,62,63,64,67,68,71,72,74-75, 83, 92, 98-99, 109, 188, 197, 199- 200, 201, 207-208 n nutrient requirements, 59, 139-144, 166 n requirement distributions, 24, 59, 62, 74-75, 140 true, 199 unexplained, 199 Vegetarian diets, 36, 136-139 Vitamin A, 2, 28, 47-48, 49, 52, 86, 114- 115, 127-132, 136, 152, 184, 192, 193, 194, 202 Vitamin Be, 28-29, 40, 49, 50, 52, 86, 110- 113, 142, 144 Vitamin Bit, 28, 49, 52, 86, 135, 136, 143- 144, 153 Vitamin C, 14, 23, 47, 49, 52, 54, 86, 98, 101, 114-115, 117-122, 135, 136, 140, 144, 185, 186-187, 194 Vitamin D, 39, 50, 52, 86, 135, 136, 139, 194 Vitamin E, 30, 49, 52, 54, 86, 135, 136, 140, 152 Vitamin K, 86, 136, 176 Vulnerable subgroups, 13-14, 15, 50, 89, 91, 95 W Weight. See also Reference heights and weights accuracy of self-reports, 93, 106 changes, 42, 168 EER and, 43 errors in reporting, 93, 106 DIETARY REFERENCE INTAKES maintaining current, 31, 41, 42, 43, 75, 76 as measure of energy intake, 41 monitoring, 43, 78, 143 nutrient density approach and, 93, 106 Wernicke-Korsakoff syndrome, 144 White House Conference on Food, Nutrition, and Health, 173 Within-person variance in intakes adjusting intake distributions for, 33, 63-64, 199-200, 204, 207-208 energy intakes, 31, 33, 41-42, 92 incomplete data and, 202-203 systematic effects on, 33, 203, 204 in usual intakes, 9, 26, 63, 64, 92, 109, 197, 198, 199 Women. See also Pregnant and lactating women EER, 42, 43 energy intakes, 99, 101, 185 folate, 28, 135, 141-142 fortified food intakes, 135, 194 iron, 38-39, 74, 90, 190 macronutrient distribution for, 44, 78- 80 menopause/hormone therapy, 142 serving size, 195 Vitamin A, 127-130, 131 Vitamin C, 101, 117-118, 119, 120, 122, 123, 185, 186-187 World Health Organization, 28 z Zinc, 10-11, 40, 49, 52, 60, 62, 70, 87, 95, 114-115, 123-126, 136-137, 198-201