data to determine a defined level of fat intake at which no risk of inadequacy or prevention of chronic disease occurs. “AMDRs were estimated for total fat based on evidence indicating a risk for coronary heart disease (CHD) at low intakes of fat and high intakes of carbohydrate, and based on evidence for increased risk for obesity and its complications, including CHD, with high intakes of fat” (IOM, 2002a). The AMDRs for fat were estimated for children (25 to 35 percent of energy for ages 4 to 18 years) primarily based on a transition from the high-fat intakes that occur during infancy to the adult AMDR for fat (20 to 35 percent of energy).

To promote healthful dietary practices and nutritionally adequate diets and to provide consistency for setting label reference values for protein, total carbohydrate, and total fat, the committee believes that an approach based on the AMDR is most appropriate. Because the AMDR for each macronutrient is expressed as percent of energy in terms relative to each other, the approach for setting their label reference values should ensure that their sum totals to 100 percent. The committee recommends using the midpoint of the AMDR for total carbohydrate (since the AMDR for carbohydrate is 45 to 65 percent of energy for all reference groups) and a population-weighted midpoint of the AMDR for total fat (using the midpoint of the range of 20 to 35 percent of energy for adults and 25 to 35 percent of energy for children 4 to 18 years of age). A reference value for protein could then be based on the difference needed for the sum of the macronutrients to equal 100 percent of energy. Using the midpoint of the AMDR as the basis for label reference values avoids extreme values (i.e., lower- or upper-boundary levels) and is an approach that focuses on moderation.

Sugars and Added Sugars

Naturally occurring and added sugars are chemically identical and analytically indistinguishable by current techniques. Naturally occurring sugars (also called intrinsic sugars) are primarily found in fruits, milk, and dairy products that also contain other essential nutrients (IOM, 2002a). Added sugars are defined as sugars and syrups that are added to food during processing and preparation.2


“Specifically, added sugars include white sugar, brown sugar, raw sugar, corn syrup, corn-syrup solids, high-fructose corn syrup, malt sugar, maple syrup, pancake syrup, fructose sweetener, liquid fructose, honey, molasses, anhydrous dextrose, and crystal dextrose. Added sugars do not include naturally occurring sugars such as lactose in milk or fructose in fruits” (IOM, 2002a, p. 6-2).

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