NUTRITIONAL RISK ASSESSMENT

Perspectives, Methods, and Data Challenges

Workshop Summary

Carol West Suitor, Ann Yaktine, and Maria Oria Rapporteurs

Food Forum

Food and Nutrition Board

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu



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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary NUTRITIONAL RISK ASSESSMENT Perspectives, Methods, and Data Challenges Workshop Summary Carol West Suitor, Ann Yaktine, and Maria Oria Rapporteurs Food Forum Food and Nutrition Board INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This study was supported by Contract No. HHSF223200730582P between the National Academy of Sciences and the U.S. Department of Health and Human Services; the Interagency Risk Assessment Consortium; the U.S. Department of Agriculture; and the International Life Sciences Institute. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 978-0-309-10871-3 (Book) International Standard Book Number 978-0-309-10872-0 (PDF) Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2007 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: Institute of Medicine (IOM). 2007. Nutritional risk assessment: Perspectives, methods, and data challenges, workshop summary. Washington, DC: The National Academies Press.

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary WORKING GROUP ON NUTRITIONAL RISK ASSESSMENT ROBERT L. BUCHANAN (Chair), Center for Food Safety and Applied Nutrition, Food and Drug Administration, U.S. Department of Health and Human Services, College Park, MD SUZANNE HARRIS, International Life Sciences Institute, Washington, DC DAVID KLURFIELD, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, MD KATHLEEN KOEHLER, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, DC MOLLY KRETSCH, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, MD MICHAEL D. McELVAINE, Office of Risk Assessment and Cost–Benefit Analysis, U.S. Department of Agriculture, Washington, DC MARIANNE MILIOTIS, Center for Food Safety and Applied Nutrition, Food and Drug Administration, U.S. Department of Health and Human Services, College Park, MD STEPHEN OLIN, International Life Sciences Institute, Washington, DC MARIA ORIA, Food and Nutrition Board, Institute of Medicine, Washington, DC CATHERINE E. WOTEKI, Mars, Incorporated, McLean, VA

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary FOOD FORUM MICHAEL P. DOYLE (Chair), University of Georgia, Griffin PAMELA ANDERSON, Ross Products Division, Abbott Laboratories, Columbus, OH RHONA APPLEBAUM, The Coca-Cola Company, Atlanta, GA JAMES D. ASTWOOD, ConAgra Foods Inc., Omaha, NE JANET BEAUVAIS, Health Canada, Ottawa, Ontario SUSAN BORRA, International Food Information Council, Washington, DC ROBERT BRACKET, Food and Drug Administration, Washington, DC JULIE CASWELL, University of Massachusetts, Amherst CELESTE A. CLARK, Kellogg Company, Battle Creek, MI DICK CRAWFORD, McDonalds Corporation, Oak Brook, IL SUSAN J. CROCKETT, General Mills, Minneapolis, MN HAMED FARIDI, McCormick & Company, Hunt Valley, MD NED GROTH III, Groth Consulting Services, Pelham, NY BRENDA HALBROOK, Department of Agriculture, Washington, DC JERRY HJELLE, Monsanto Company, St. Louis, MO GILBERT A. LEVEILLE, Cargill, Wayzata, MN JOSEPH A. LEVITT, Hogan & Hartson L.L.P., Washington, DC ALICE H. LICHTESTEIN, Tufts University, Boston, MA DONNA PORTER, Library of Congress, Washington, DC PRISCILLA SAMUEL, Mead Johnson Nutrition, Evansville, IN FRED R. SHANK, Institute of Food Technologists, Washington, DC WILLIAM SVEUM, Kraft Foods, Glenview, IL STEVE L. TAYLOR, University of Nebraska, Lincoln BRIAN WANSINK, Cornell University, Ithaca, NY CATHERINE E. WOTEKI, Mars, Incorporated, McLean, VA

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary FOOD AND NUTRITION BOARD* DENNIS M. BIER (Chair), Children’s Nutrition Research Center, Houston, TX MICHAEL P. DOYLE (Vice Chair), Center for Food Safety, University of Georgia, Griffin DIANE BIRT, Department of Food Science and Human Nutrition, Iowa State University, Ames YVONNE BRONNER, School of Public Health and Policy, Morgan State University, Baltimore, MD FERGUS M. CLYDESDALE, Department of Food Science, University of Massachusetts, Amherst GORDON L. JENSEN, Department of Nutritional Sciences, Pennsylvania State University, University Park REYNALDO MARTORELL, Department of Global Health, Emory University, Atlanta, GA SUSAN T. MAYNE, Division of Chronic Disease Epidemiology, Yale University School of Medicine, New Haven, CT SANFORD A. MILLER, Center for Food, Nutrition, and Agriculture Policy, University of Maryland, College Park J. GLENN MORRIS, JR., Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University of Hawaii, Honolulu JOSE M. ORDOVAS, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA MARTIN A. PHILBERT, School of Public Health, University of Michigan, Ann Arbor JIM E. RIVIERE, Center for Chemical Toxicology Research and Pharmacokinetics, North Carolina State University, Raleigh REBECCA J. STOLTZFUS, Division of Nutritional Sciences, Cornell University, Ithaca, NY PATRICK J. STOVER, Division of Nutritional Sciences, Cornell University, Ithaca, NY WALTER C. WILLETT, Department of Nutrition, Harvard School of Public Health, Boston, MA

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary Staff LINDA D. MEYERS, Director GERALDINE KENNEDO, Administrative Assistant ANTON L. BANDY, Financial Associate * IOM Boards do not review or approve individual workshop summaries. The responsibility for the content of the summary rests with the rapporteurs and the institution.

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary Independent Report Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Diane F. Birt, Department of Food Science and Human Nutrition, Center for Research on Botanical Dietary Supplements, Iowa State University Christine Chaisson, LifeLine Group, Inc. Susan Ferenc, Chemical Producers and Distributors Association Donna V. Porter, Domestic Social Policy Division, Congressional Research Service Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by A. Catharine Ross, Department of Nutritional Sciences, Pennsylvania State University. Appointed by the Institute of Medicine, she was responsible for making certain that an independent

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.

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Nutritional Risk Assessment: Perspectives, Methods, and Data Challenges - Workshop Summary Contents     OVERVIEW   1 1   INTRODUCTION   5 2   RISK ASSESSMENT AND NUTRITION: SHARING PERSPECTIVES   7 3   AN EXAMINATION OF CURRENT AND POTENTIAL NUTRITIONAL RISK ASSESSMENT METHODS   25 4   ESTABLISHING RELATIONSHIPS BETWEEN DIETARY PATTERNS AND HEALTH OUTCOMES   49 5   NEW DEVELOPMENTS IN AND CHALLENGES TO NUTRITIONAL RISK ASSESSMENT   65 6   PERSPECTIVES ON CHALLENGES AND SOLUTIONS: SUMMARY REMARKS AND SUGGESTED NEXT STEPS   79     REFERENCES   89     APPENDIXES     A   Workshop Agenda   99 B   Workshop Participants   105 C   Speaker, Moderator, and Discussant Biographies   117 D   Acronyms and Abbreviations   133

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