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DRI DIETARY REFERENCE INTAKES: Applications in Dietary Assessment
INDIVIDUAL ASSESSMENT FOR NUTRIENTS WITH AN AI
Before discussing a statistical approach to individual assessment for nutrients with an Adequate Intake (AI) instead of an Estimated Average Requirement (EAR), it is critical to emphasize the difference between these two Dietary Reference Intakes (DRIs). The EAR represents the median nutrient requirement of a given life stage and gender group, and by definition, an intake at the level of the EAR will be inadequate for half the group. In contrast, the AI represents an intake that is likely to exceed the actual requirements of almost all healthy individuals in a life stage and gender group. In this respect it is analogous to the Recommended Dietary Allowance (RDA); however, because of the imprecise nature of the data used to establish AIs, it may often be higher than an RDA would be if appropriate data were available to calculate one.
The approach discussed previously to assess nutrient adequacy compares an individual's intake to the EAR, and considers variability in both intake and requirement when determining how confident one can be in concluding that intake is adequate. In other words, intakes are compared to median requirements. In the case of the AI, however, intakes are compared to an intake value already in excess of the median requirement, perhaps by a very large margin. Thus, when intakes are compared to the AI, all one can truly conclude is whether intake is above the AI or not. Although an intake that is statistically above the AI is certainly adequate, intakes below the AI are also likely to be adequate for a considerable proportion of individuals. Thus, great caution must be exercised when interpreting intakes relative to AIs.
How can individual assessment be carried out when the nutrient of interest does not have an EAR? Using calcium as an example, one is limited to comparing the individual's usual intake to the AI. The conclusions that can be drawn from such a comparison are rather narrow: if the usual intake is determined with desired accuracy to be larger than the AI, then the individual's usual intake of the nutrient is likely to be adequate. The converse, however, is not true. At the desired level of confidence, nothing can be concluded from the analysis if it is found that the individual's usual intake is not larger than the AI.
A simple z-test to decide whether an individual's unobservable usual intake is larger than the AI can be used. The test assumes that daily intakes for an individual have a distribution that is approximately normal around the individual's usual intake. The SD of daily intake is necessary to carry out the test. Because large numbers of