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Dietary Reference Intakes: Applications in Dietary Assessment (2000)
Institute of Medicine (IOM)

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. "6 Using the Tolerable Upper Intake Level for Nutrient Assessment of Groups." Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press, 2000.

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DRI DIETARY REFERENCE INTAKES: Applications in Dietary Assessment

For some nutrients (e.g., fluoride, phosphorus, vitamin C) the distribution of usual intake would need to include intake from all sources, while for others (e.g., magnesium, folate, niacin, vitamin E) only the distribution of usual supplement intake would be needed.

Figure 6-1 provides a hypothetical example of the relationship between population median intakes and the risk function for intakes at all levels. It can be seen that the percentage of the population at risk would differ depending on the steepness of the risk function. As noted above, however, the risk function (the dose-response curve) for all nutrients is unknown.

Figure 6-2 illustrates a distribution of usual nutrient intakes in a population; the proportion of the population with usual intakes above the UL represents the potential at-risk group. An evaluation of the public health significance of the risk to the population consuming a nutrient in excess of the UL would be required to determine if action was needed.

If no discernible portion of the population consumes the nutrient in excess of the UL, no public health risk should exist. However, if

FIGURE 6-1 Hypothetical example of risk of adverse effects compared to population intake. The fraction of the population having usual nutrient intakes above the Tolerable Upper Intake Level (UL) is potentially at risk; the probability of adverse effects increases as nutrient intakes increase above the UL, although the true risk function is not known for most nutrients. NOAEL = no-observed-adverse-effect level, LOAEL = lowest-observed-adverse-effect level.

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121
Front Matter (R1-R14)
Contents (R15-R18)
Summary (1-18)
I. Historical Perspective and Background (19-20)
1 Introduction and Background (21-28)
2 Current Uses of Dietary Reference Standards (29-42)
II. Application of DRIs for Individual Diet Assessment (43-44)
3 Using Dietary Reference Intakes for Nutrient Assessment of Individuals (45-70)
III. Application of DRIs for Group Diet Assessment (71-72)
4 Using the Estimated Average Requirement for Nutrient Assessment of Groups (73-105)
5 Using the Adequate Intake for Nutrient Assessment of Groups (106-112)
6 Using the Tolerable Upper Intake Level for Nutrient Assessment of Groups (113-126)
7 Specific Applications: Assessing Nutrient Intakes of Groups Using the Dietary Reference Intakes (127-144)
IV. Fine-Tuning Dietary Assessment Using the DRIs (145-146)
8 Minimizing Potential Errors in Assessing Group and Individual Intakes (147-161)
9 Research Recommended to Improve the Uses of Dietary Reference Intakes (162-167)
10 References (168-178)
Appendix A: Origin and Framework of the Development of Dietary Reference Intakes (179-184)
Appendix B: Nutrient Assessment of Individuals: Statistical Foundations (185-202)
Appendix C: Assessing Prevalence of Inadequate Intakes for Groups: Statistical Foundations (203-210)
Appendix D: Assessing the Performance of the EAR Cut-Point Method for Estimating Prevalence (211-231)
Appendix E: Units of Observation: Assessing Nutrient Adequacy Using Household and Population Data (232-238)
Appendix F: Rationale for Setting Adequate Intakes (239-253)
Appendix G: Glossary and Abbreviations (254-261)
Appendix H: Biographical Sketches of Subcommittee Members (262-266)
Index (267-281)
Summary Table: Estimated Average Requirements (282-283)
Summary Table: Tolerable Upper Intake Levels (284-286)
Summary Table: Recommended Intakes for Individuals (287-289)