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Dietary Supplements: A Framework for Evaluating Safety (2005)
Institute of Medicine (IOM)

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. "3 The Framework." Dietary Supplements: A Framework for Evaluating Safety. Washington, DC: The National Academies Press, 2005.

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Dietary Supplements: A Framework for Evaluating Safety

determine if a significant or unreasonable risk of illness or injury exists when consuming a nutrient as a dietary supplement at its suggested level of intake. This is the integrative evaluation component.

An integrative evaluation should use as its basis the DRI review and analysis, recognizing that for some nutrients (i.e., vitamin K, β-carotene, arsenic, chromium, silicon, thiamin, riboflavin, vitamin B12, pantothenic acid, biotin, potassium, and sulfate) the available data, while reviewed in the DRI series, were deemed insufficient to develop a UL based on requirements of the model of risk assessment used. This does not indicate that high intakes pose no risk of adverse effects (IOM, 1998a, 2000, 2001, 2004), but that a thorough review by an expert group could not identify dose- response evidence from chronic intakes that would provide a basis for establishing the level at which adverse effects might occur.

If a UL was not established for the vitamin or mineral element under question, it is important to consider the following:

  • Was the substance reviewed by the DRI process, even if a UL was not established?

  • Is there new evidence suggesting risk that was not available at the time of the DRI review?

  • Was significant concern about serious harm expressed in the DRI review, even if a DRI could not be established because of limits in the data or acuteness of the adverse effect (e.g., arsenic)?

It is assumed that the integrative evaluation for a nutrient would contain the same general components as for other dietary supplement ingredients, with the exception that significant information is already captured by virtue of the DRI process and its reports. In situations where new data or information indicate that higher concern is warranted, the nutrient would enter the evaluation in the same manner as other supplement ingredients. Nutrients are usually well-characterized chemically and thus there is less concern about active ingredient identification and function.

ANNEX 3-2 MONOGRAPH PREPARATION AND PUBLIC ACCESS

Preparation of Draft Monographs

In evaluating evidence indicating that an ingredient may present an unreasonable risk to human health, a comprehensive examination of the literature is required, recognizing that not all studies are relevant to ascertaining the safety of a dietary supplement ingredient. The initial step in

Page
121
Front Matter (R1-R20)
Executive Summary (1-18)
1 Introduction and Background (19-42)
2 Approaches Used by Others and Existing Safety Frameworks (43-84)
3 The Framework (85-125)
4 Categories of Scientific Evidence--Human Information and Data (126-155)
5 Categories of Scientific Evidence--Animal Data (156-174)
6 Categories of Scientific Evidence--Information About Related Substances (175-216)
7 Categories of Scientific Evidence--In Vitro Data (217-234)
8 Interactions (235-246)
9 Vulnerable Groups and Prevalance of Use (247-252)
10 Scientific Principles for Integrating and Evaluating the Available Data (253-268)
11 Applying the Framework: Case Studies Using the Prototype Safety Monographs (269-291)
12 Factors Influencing Use of the Safety Framework (292-296)
13 Findings and Recommendations (297-306)
Appendix A: Existing Frameworks or Systems for Evaluating the Safety of Other Substances (307-315)
Appendix B: Scope of Work and Comments to Initial July 2002 Framework (316-321)
Appendix C: Plant Family Information (322-355)
Appendix D: Chaparral: Prototype Monograph Summary (356-362)
Appendix E: Glucosamine: Prototype Monograph Summary (363-366)
Appendix F: Melatonin: Prototype Monograph Summary (367-371)
Appendix G: Chromium Picolinate: Prototype Monograph Summary (372-375)
Appendix H: Saw Palmetto: Prototype Monograph Summary (376-379)
Appendix I: Shark Cartilage: Prototype Monograph Summary (380-384)
Appendix J: Prototype Focused Monograph: Review of Liver-Related Risks for Chaparral (385-449)
Appendix K: Protoype Focused Monograph: Review of Anti-Androgenic Risks of Saw Palmetto Ingestion by Women (450-477)
Appendix L: Acknowledgements (478-480)
Appendix M: Biographical Sketches of Commitee Members (481-488)
Index (489-506)