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Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate
factors; and the power of the study to demonstrate a given difference or correlation. Publications solely expressing opinions were not used in setting DRIs. The assessment acknowledged the inherent reliability of each type of study design as described above, and it applied standard criteria concerning the strength, dose-response, and temporal pattern of estimated nutrient-disease or adverse effect associations, the consistency of associations among studies of various types, and the specificity and biological plausibility of the suggested relationships (Hill, 1971). For example, biological plausibility would not be sufficient in the presence of a weak association and lack of evidence that exposure preceded the effect.
Data were examined to determine whether similar estimates of the requirement resulted from the use of different indicators and different types of studies. In the DRI model described in Chapter 1, for a single nutrient, the criterion for setting the Estimated Average Requirement (EAR) may differ from one life stage group to another because the critical function or the risk of disease may be different. When no or very poor data are available for a given life stage group, extrapolation is made from the EAR or Adequate Intake (AI) set for another group (see later section on extrapolation); explicit and logical assumptions on relative requirements were made. Because EARs can be used for multiple purposes, unlike AIs, they are established whenever sufficient supporting data were available.
Although the reference values in these DRI reports are based on data, the data were often scanty or drawn from studies that had limitations in addressing the various questions that confronted the panel. Therefore, many of the questions raised about the requirements for and recommended intakes of these nutrients cannot be answered fully because of inadequacies in the present database. Apart from studies of overt deficiency diseases, there is a dearth of studies that address specific effects of inadequate intakes on specific indicators of health status, and thus a research agenda is proposed (see Chapter 9). For many of the nutrients in the DRI reports, estimated requirements are based on factorial, balance, and biochemical indicator data because there is little information relating health status indicators to functional sufficiency or insufficiency.
Thus, after careful review and analysis of the evidence, including examination of the extent of congruent findings, scientific judg-