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

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. "Appendix D: Assessing the Performance of the EAR Cut-Point Method for Estimating Prevalence." 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

is also needed in order to estimate the prevalence of inadequacy.

In addition, it was stated that the estimates of inadequacy would be essentially unbiased when the actual prevalence of inadequacy in the group is close to 50 percent. As the true prevalence approaches 0 or 100 percent, the performance of the EAR cut-point method declines, even if the conditions listed above are met.

To test the EAR cut-point method, some preliminary simulation studies were performed. The reliability of this method of estimating the prevalence of inadequacy was evaluated in cases where the assumptions above were met, and also in cases in which one or more of the assumptions were violated. For example, the EAR cut-point method was used to evaluate groups in which (1) intakes and requirements were correlated (for example, food energy), (2) the standard deviation of requirements (SDr) was larger than the standard deviation of usual intakes (SDi), and (3) the distribution of requirements was skewed (as is the case of iron in menstruating women).

This appendix does not test the performance of the probability approach. The probability approach, by construction, will perform well whenever intakes and requirements are independent, and whenever the form of the distribution of requirements is known. As in the EAR cut-point method, a reliable estimate of the distribution of usual intakes in the group must be available to ensure an unbiased estimate of the prevalence of inadequacy in the group.

Results of the simulation studies are reported in three sections. The first section examines the impact of violating the independence assumption on the estimates of prevalence. In the second section, the robustness of the EAR cut-point method to departures from the assumption of small SDr relative to SDi is tested. Finally, in the third section, the effects of departures from the assumption of a symmetrical requirement distribution are considered. In each section, a description of how the simulations were run is followed by a summary of the major findings. The simulation studies presented are preliminary and by no means definitive. They are intended to provide initial insight into the performance of this short-cut of the probability approach for estimating inadequacy. It is hoped that this report will encourage other researchers to proceed from the information presented here and conduct further research on this important topic.

INTAKES AND REQUIREMENTS ARE CORRELATED

The impact of violating the assumption of independence between intakes and requirements was evaluated by estimating prevalence of

Page
212
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)