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

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. "Appendix B: Nutrient Assessment of Individuals: Statistical Foundations." 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

Data presented in Table B-2, Table B-3, Table B-4 through Table B-5 indicate that it is not possible to use this approach to assess the adequacy of vitamin A, vitamin C, vitamin E, and some other nutrients. In these cases, the distribution of daily intakes cannot be assumed to be normal, and thus observed daily intake cannot be used to carry out the assessment.

Because the distributions of daily intake for many nutrients are nonnormal, more research is needed in order to extend this methodology to all nutrients of interest.

Requirement Distribution Is Not Normal

The proposed approach relies also on normality of the requirement distribution. When requirements are not distributed in a symmetrical, approximately normal fashion around the EAR, results may be biased. For example, the confidence with which it can be concluded that intake is adequate may be less than 85 percent even though the observed ratio D/SDD is equal to 1.

Iron is an example of a nutrient for which the distribution of requirements is not normal. Iron requirements in menstruating women are skewed, with a long tail to the right. In this situation, the method described above does not produce reliable results. No alternative can be offered at this time; more research is needed in this area.

Incorrect Specification of the SD of Requirement

Until now, little if any attention has been paid to reliably estimating the variance of nutrient requirement distributions. DRI reports (IOM, 1997, 1998b, 2000) have assumed that the CV of requirements for most nutrients is 10 percent of the EAR, unless other information is known (e.g., niacin is given as 15 percent). Given an EAR and a CV of requirement, an SD of requirement can be calculated as SDr = CV × EAR. For example, if the EAR of a nutrient is 120 units/day and the CV of requirement is 10 percent, then the SD of requirement will be 0.1 × 120 = 12 units/day.

It is not clear that the fixed 10 percent (or 15 percent) CV estimates across nutrients result in reliable estimators of the SD of requirement. Since the SD of requirement is an important component of the SD of D, an inaccurate value of SDr will result in an inaccurate value of SDD and hence an inaccurate value of the ratio D/SDD.

At this time, no better alternatives than using the CV of the requirement as given in the DRI reports have been identified, and thus the results of such analyses should be interpreted with caution.

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197
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)