particularly if there is no corroborating evidence of energy inadequacy in the population.

A CONCEPTUAL MODEL

Use of the Tolerable Upper Intake Levels

When the UL was first introduced in the DRI report on calcium and related nutrients, one rationale for its development was concern about “… the increased fortification of foods with nutrients and the use of dietary supplements by more people and in larger doses” (IOM, 1997, p. 26). As mentioned in the original description of the model for the ULs (IOM, 1997), nutrients can be viewed like other chemical agents as having the potential to produce adverse health effects from excessive ingestion via the various sources available: conventional food, dietary supplements, and drugs. The UL is specifically defined as “… the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects for almost all individuals in the specified life stage group” (IOM, 2002a). After discussing several possible approaches, the DRI Subcommittee on Upper Reference Levels of Nutrients determined that the science bases for nutrients and toxicology at the time best lent itself to a risk assessment framework for deriving ULs. The term “tolerable” was included as part of the name for this reference value because it connotes a level of intake that can be biologically tolerated, yet with regular intake above the UL there is the potential for increased risk of adverse health effects. The definition of an adverse effect underlying the ULs is broad. This breadth has led to significant diversity in the severity of the adverse effects, the typical ingestion sources (e.g., food, supplements, pharmaceutical preparations), and the rationale for intake (e.g., nourishment, treatment regime, prevention) that have been used as the basis for the ULs. These factors, as well as the specific details of the derivation of the UL, must be taken into account when considering discretionary fortification.

Discretionary Fortification Decision Making

Guiding Principle 11 implies that existing food- and supplement-intake databases should be used to determine exposure of population groups to the nutrient proposed for fortification, and that the EAR should be used as a basis for this determination. The committee also made the following assumptions:



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