with dietary intake assessment have been discussed at length in the DRI assessment and planning reports (IOM, 2000a, 2003). Briefly, errors can arise in the estimation of usual food and nutrient intakes because of random and systematic errors in self-reporting of intakes (particularly systematic underreporting of intakes), estimation of usual intake levels from observed intakes, and determination of the nutrient content of a particular food (because of incomplete or erroneous food composition data).

Although knowledge of these measurement errors continues to grow and methods have been proposed to assess the accuracy of self-reported dietary intakes, there are limited tools with which to identify and correct such errors in population survey data. Because the determination of dietary inadequacy rests on an evaluation of the adequacy of usual nutrient intake levels in the population, errors in the measurement of usual intake levels pose a serious threat to this process. The prevalence of nutrient inadequacy could be grossly overestimated if there are high levels of underreporting in the dietary intake data or if the food composition database includes incomplete or erroneous data on the levels of a particular nutrient in food. Errors also are introduced into measurements of dietary supplement intake because formulations change frequently, and individuals who participate in surveys often have difficulty identifying the exact supplement brand or formulation they used, as well as the duration and regularity of use. Such problems need to be addressed before dietary intake assessments alone are used as a basis for discretionary fortification.

Given the limitations of dietary intake data, evidence of nutrient inadequacy from dietary intake assessments should be verified whenever possible by comparisons with other biochemical or clinical evidence of nutrient inadequacies at the population level. Congruence between dietary and biochemical indices of nutrient inadequacy is particularly valuable in establishing that problems of dietary inadequacy identified through dietary assessments are indeed of public health importance. Conversely, conflicting evidence of dietary insufficiencies need to be carefully reviewed before discretionary fortification could be scientifically justified as providing a potential public health benefit.

Health Risks Associated with Nutrient Inadequacy

Evidence of dietary inadequacy also needs to be weighed against the criteria used to determine the requirements for a particular nutrient. A prevalence of nutrient inadequacy based on nutrient

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