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Dietary Reference Intakes: Applications in Dietary Assessment (2000)

Chapter: Appendix F: Rationale for Setting Adequate Intakes

« Previous: Appendix E: Units of Observation: Assessing Nutrient Adequacy Using Household and Population Data
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
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F

Rationale for Setting Adequate Intakes

In the Dietary Reference Intake (DRI) nutrient reports, the Adequate Intake (AI) has been estimated in a number of different ways. Because of this, the exact meanings and interpretations of the AIs differ. Some AIs have been based on the observed mean intake of groups or subpopulations that are maintaining health and nutritional status consistent with meeting the criteria for adequacy. However, where reliable information about these intakes was not available, or where there were conflicting data, other approaches were used. As a result, the definition of an AI is broad and includes experimentally estimated desirable intakes.

These varying methods of setting an AI make using the AI for assessing intakes of groups difficult. When the AI is based directly on intakes of apparently healthy populations, it is correct to assume that other populations (with similar distributions of intakes) have a low prevalence of inadequate intakes if the mean intake is at or above the AI. For nutrients for which the AI was not based on intakes of apparently healthy populations, a group mean intake at or above the AI would still indicate a low prevalence of inadequate intakes for that group but there is less confidence in this assessment. Table F-1, Table F-2, Table F-3, Table F-4, Table F-5 through Table F-6 give more details on the methods used to set the AIs for calcium, vitamin D, fluoride, pantothenic acid, biotin, and choline. For infants, AIs have been set for all nutrients evaluated to date (see table at the end of this book). For all these nutrients except vitamin D, the AI for infants is based on intakes of healthy populations that are fed only human milk. How-

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

ever, for the other age groups, only fluoride and pantothenic acid AIs are based on intakes of apparently healthy populations.

TABLE F-1 Adequate Intake (AI) for Calcium

Life Stage Group

AI (mg/d)

Basis for AI

0–6 mo

210

Human milk content

7–12 mo

270

Human milk content + solid food

1–3 y

500

Extrapolation from AI for 4–8 y (desirable calcium retention)

4–8 y

800

Calcium balance, calcium accretion, ∆BMCb

9–18 y

1,300

Desirable calcium retention, ∆BMC, factorial

19–30 y

1,000

Desirable calcium retention, factorial

31–50 y

1,000

Calcium balance, BMDc

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

Study Populationa

Balance studies:

n=60 girls and 39 boys; aged 2–8 y; normal and healthy (Matkovic, 1991; Matkovic and Heaney, 1992)

Retention studies:

  1. n=115 girls and 113 boys; aged 9–19 y (Martin et al., 1997)

  2. n=80; aged 12–15 y; Caucasians (Greger et al., 1978; Jackman et al., 1997; Matkovic et al., 1990)

  3. n=111 girls and 22 boys; aged 9–17 y; normal and healthy (Matkovic and Heaney, 1992)

BMC studies:

  1. n=94 Caucasian girls; mean age 12 y (Lloyd et al., 1993)

  2. n=48 Caucasian girls; mean age 11 y (Chan et al., 1995)

  3. n=70 pairs of identical twins; aged 6–14 y; 45 pairs completed the 3-y study (Johnston et al., 1992)

n=26 men and 137 women; aged 18–30 y; normal and healthy (Matkovic and Heaney, 1992)

Balance studies:

  1. n=130 premenopausal women (white Roman Catholic nuns); aged 35–50 y (Heaney et al., 1977)

  2. n=25 healthy women; aged 30–39 y (Ohlson et al., 1952)

  3. n=34 healthy women; aged 40–49 y (Ohlson et al., 1952)

BMD studies:

  1. n=37 premenopausal women; aged 30–42 y (Baran et al., 1990)

  2. n=49 premenopausal, healthy women; aged 46–55 y; Netherlands (Elders et al., 1994)

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

TABLE F-1 Adequate Intake (AI) for Calcium

Life Stage Group

AI (mg/d)

Basis for AI

51–70 y

1,200

Desirable calcium retention, factorial, ∆BMD

> 70 y

1,200

Extrapolation from AI for 51–70 y (desirable calcium retention), ∆BMD, fracture rate

Pregnancy and lactation, <18 y

1,300

Bone mineral mass

Pregnancy and lactation, 19–50 y

1,000

Bone mineral mass

a Unless noted otherwise, all studies were performed in the United States or Canada.

b ∆BMC = change in bone mineral content.

c ∆BMD = change in bone mineral density.

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

Study Population

Retention studies:

  1. n=85 women with vertebral osteoporosis; aged 48–77 y (Hasling et al., 1990) (Selby, 1994)

  2. n=18 women and 7 men with osteoporosis; aged 26–70 y, mean age 53

  3. n=181 balance studies of ambulatory men; aged 34–71 y, mean age 54 (Spencer et al., 1984)

  4. n=76 women; aged 50–85 y (Ohlson et al., 1952)

  5. n=61 postmenopausal women with osteoporosis (Marshall et al., 1976)

  6. n=41 postmenopausal, estrogen-deprived women (white Roman Catholic nuns); mean age 46 y (Heaney and Recker, 1982; Heaney et al., 1978)

BMD studies:

  1. n=9 clinical trials in postmenopausal women (Aloia et al., 1994; Chevalley et al., 1994; Dawson-Hughes et al., 1990; Elders et al., 1991; Prince et al., 1991, 1995; Recker et al., 1996; Reid et al., 1995; Riis et al., 1987)

  2. n =77 men; aged 30–87 y, mean age 58; 3-y study (Orwoll et al., 1990)

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

TABLE F-2 Adequate Intake (AI) for Vitamin D

Life Stage Group

AI (μg/d)

Basis for AI

0–6 mo

5

Serum 25(OH)Db level

7–12 mo

5

Serum 25(OH)D level

1–3 y

4–8 y

9–13 y

14–18 y

5

Serum 25(OH)D level

19–50 y

5

Serum 25(OH)D level

51–70 y

10

Serum 25(OH)D level

>70 y

15

Serum 25(OH)D level

Pregnancy and lactation, all ages

5

Serum 25(OH)D level

a Unless noted otherwise, all studies were performed in the United States or Canada.

b 25 (OH)D = 25-hydroxyvitamin D.

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

Study Populationa

n= 256 full-term Chinese infants (Specker et al., 1992)

  1. n=18 healthy, full-term, human-milk-fed infants; 17 Caucasian, 1 Asian-Indian (Greer et al., 1982)

  2. n=150 normal, full-term, formula-fed Chinese infants (Leung et al., 1989)

  3. n=38 healthy infants, aged 6–12 months; Norway (Markestad and Elzouki, 1991)

  1. n=104 boys and 87 girls; healthy, normal; aged 8–18 y; Norway (Aksnes and Aarskog, 1982)

  2. n=90 randomly selected school students in Turkey; 41 girls, 49 boys; aged 6–17 y (Gultekin et al., 1987)

  1. n=52 women; aged 25–35 y (Kinyamu et al., 1997)

  1. n=247 healthy, postmenopausal, ambulatory women; mean age 64 y (Dawson-Hughes et al., 1995)

  2. n=333 healthy, postmenopausal, Caucasian women; mean age 58 y (Krall et al., 1989)

  3. n=249 healthy, postmenopausal, ambulatory women; mean age 62 y (Dawson-Hughes et al., 1991)

  1. n=60 women living in a nursing home, mean age 84 y; and 64 free-living women, mean age 71 y (Kinyamu et al., 1997)

  2. n=109 men and women living in a nursing home; mean age 82 y (O'Dowd et al., 1993)

  3. n=116 men and women; mean age 81 y (Gloth et al., 1995)

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

TABLE F-3 Adequate Intake (AI) for Fluoride

Life Stage Group

AI (mg/d)a

Basis for AI

0–6 mo

0.01

Human milk content

7–12 mo

0.5

Caries prevention

1–3 y

0.7

Caries prevention

4–8 y

1

Caries prevention

9–13 y

2

Caries prevention

14–18 y, males

3

Caries prevention

14–18 y, females

3

Caries prevention

>19 y, males

4

Caries prevention

>19 y, females

3

Caries prevention

Pregnancy and lactation, <18 y

3

Caries prevention

Pregnancy and lactation, 19–50 y

3

Caries prevention

a For all life stage groups, the AI was calculated using 0.05 mg/kg/day as the amount of fluoride needed to prevent dental caries. This amount was based on the studies outlined in this table.

b Unless noted otherwise, all studies were performed in the United States or Canada.

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

Study Populationb

Caries prevention was based on the following studies that measured or calculated fluoride intake in children:

  1. number of infants not given; aged 1–9 y (McClure, 1943)

  2. calculated total daily fluoride intake for a typical infant at age 2, 4, and 6 mo using food analyses and caloric intake estimates (Singer and Ophaug, 1979)

  3. calculated average daily fluoride intake for a typical 6-mo-old infant and 2-y-old child using U.S. Food and Drug Administration food consumption estimates and food analyses; calculations were done for four dietary regions in the United States (Ophaug et al., 1980a, b, 1985)

  4. calculated fluoride intake from 24-h dietary recalls of 250 mothers as part of Nutrition Canada Survey (Dabeka et al., 1982)

Caries prevention was based on the following studies which measured or calculated fluoride intake in adults:

  1. analyzed duplicate diets of 24 adults and determined mean dietary intake (Dabeka et al., 1987)

  2. analyzed hospital diet; n=93 food items (Taves, 1983)

  3. measured dietary intake of 10 adult male hospital patients (Spencer et al., 1981)

  4. calculated total daily intake for typical males aged 15–19 y using food composition and consumption data (Singer et al., 1980, 1985)

  5. determined average daily intake from analysis of hospital diet; n=287 diets (Osis et al., 1974)

  6. calculated daily intake from food analyses of diets from 16 U.S. cities (Kramer et al., 1974)

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

TABLE F-4 Adequate Intake (AI) for Pantothenic Acid

Life Stage Group

AI (mg/d)

Basis for AI

0–6 mo

1.7

Human milk content

7–12 mo

1.8

Mean of extrapolation from AI for 0–6 mo and adult AIb

1–3 y

2

Extrapolation from adult AI

4–8 y

3

Extrapolation from adult AI

9–13 y

4

Extrapolation from adult AI

14–18 y

5

Extrapolation from adult AI, urinary pantothenate excretion

≥ 19 y

5

Usual intake

Pregnancy, all ages

6

Usual intake

Lactation, all ages

7

Usual intake, maternal blood concentrations, secretion of pantothenic acid into milk

a Unless noted otherwise, all studies were performed in the United States or Canada.

b To extrapolate from the AI for adults to an AI for children, the following formula is used AIchild = AIadult (F), where F = (Weightchild/Weightadult)0.75 (1 + growth factor). To extrapolate from the AI for infants ages 0–6 months to an AI for infants ages 7–12 months, the following formula is used: AI7–12mo= AI0–6mo (F), where F = (Weight7–12mo/ Weight0–6mo)0.75.

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

Study Populationa

  1. n=26 boys aged 14–19 y and 37 girls aged 13–17 y; all healthy volunteers (Eissenstat et al., 1986)

  2. n=8 boys and 4 girls; aged 11–16 y (Kathman and Kies, 1984)

Usual intake was based on 4 studies:

  1. n=23 (16 females, 7 males), aged 18–53 y (mean 26 y), 19 Caucasian, 4 Chinese, all normal healthy volunteers (Kathman and Kies, 1984)

  2. n=7,277 randomly selected British households from the U.K. National Food Survey (Bull and Buss, 1982)

  3. n=37 males, 54 females (26 institutionalized, 65 noninstitutionalized), aged 65+ y (Srinivasan et al., 1981)

  4. n=12 healthy men, half were aged 21–35 y and half were aged 65–79 y (Tarr et al., 1981)

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

TABLE F-5 Adequate Intake (AI) for Biotin

Life Stage Group

AI (μg/d)

Basis for AI

0–6 mo

5

Human milk content

7–12 mo

6

Extrapolation from AI for 0–6 moa

1–3 y

8

Extrapolation from AI for 0–6 mob

4–8 y

12

Extrapolation from AI for 0–6 mob

9–13 y

20

Extrapolation from AI for 0–6 mob

14–18 y

25

Extrapolation from AI for 0–6 mob

Adults, all ages

30

Extrapolation from AI for 0–6 moc

Pregnancy, all ages

30

Extrapolation from AI for 0–6 mo

Lactation, all ages

35

Extrapolation from AI for 0–6 mo + amount of biotin secreted into milk

a To extrapolate from the AI for infants ages 0–6 months to an AI for infants ages 7–12 months, the following formula is used: AI7–12mo = AI0–6mo (F), where F = (Weight7–12mo/ Weight0–6mo)0.75.

b To extrapolate from the AI for infants ages 0-6 months to an AI for children and adolescents 1-18 years, the following formula is used: AIchild = AI0-6mo (F), where F = (Weightchild/Weight0-6mo)0.75.

c To extrapolate from the AI for infants ages 0-6 months to an AI for adults, the following formula is used: AIadult = AI0-6mo (F), where F = (Weightadult/Weight0-6mo)0.75.

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

Study Population

  1. n= 35 mature milk samples from 38 healthy nursing mothers in Japan (Hirano et al.,1992)

  2. n=140 healthy, full-term infants in Finland; 4 mo lactation (Salmenpera et al., 1985)

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

TABLE F-6 Adequate Intake (AI) for Choline

Life Stage Group

AI (mg/d)

Basis for AI

0–6 mo

125

Human milk content

7–12 mo

150

Extrapolation from AI for 0–6 moa

1–3 y

200

Extrapolation from adult AI

4–8 y

250

Extrapolation from adult AI

9–13 y

375

Extrapolation from adult AI

14–18 y, males

550

Extrapolation from adult AI

14–18 y, females

400

Extrapolation from adult AI

≥19 y, males

550

Prevention of ALTb abnormalities

≥19 y, females

425

Prevention of ALT abnormalities

Pregnancy, all ages

450

Prevention of ALT abnormalities + cost of pregnancy

Lactation, all ages

550

Prevention of ALT abnormalities + amount of choline secreted into milk

a To extrapolate from the AI for adults to an AI for children, the following formula is used AIchild= AIadult (F), where F = (Weightchild/Weightadult)0.75 (1 + growth factor). To extrapolate from the AI for infants ages 0–6 months to an AI for infants ages 7–12 months, the following formula is used: AI7–12mo = AI0–6mo (F), where F = (Weight7–12mo/ Weight0–6mo)0.75.

b ALT = alanine aminotransferase.

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

Study Population

n=16 healthy male volunteers; aged 29 y (Zeisel et al., 1991)

Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 239
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 240
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 241
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 242
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 243
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 244
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 245
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 246
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 247
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 248
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 249
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 250
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 251
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 252
Suggested Citation:"Appendix F: Rationale for Setting Adequate Intakes." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×
Page 253
Next: Appendix G: Glossary and Abbreviations »
Dietary Reference Intakes: Applications in Dietary Assessment Get This Book
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Since 1994 the Institute of Medicine's Food and Nutrition Board has been involved in developing an expanded approach to developing dietary reference standards. This approach, the Dietary Reference Intakes (DRIs), provides a set of four nutrient-based reference values designed to replace the Recommended Dietary Allowances (RDAs) in the United States and the Recommended Nutrient Intakes (RNIs) in Canada. These reference values include Estimated Average Requirement (EAR), Recommended Dietary Allowance (RDA), Adequate Intake (AI), and Tolerable Upper Intake Level (UL). To date, several volumes in this series have been published.

This new book, Applications in Dietary Assessment, provides guidance to nutrition and health research professionals on the application of the new DRIs. It represents both a "how to" manual and a "why" manual. Specific examples of both appropriate and inappropriate uses of the DRIs in assessing nutrient adequacy of groups and of individuals are provided, along with detailed statistical approaches for the methods described. In addition, a clear distinction is made between assessing individuals and assessing groups as the approaches used are quite different. Applications in Dietary Assessment will be an essential companion to any-or all-of the DRI volumes.

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