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

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. "3 Using Dietary Reference Intakes for Nutrient Assessment of Individuals." 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

cable to all nutrients because they assume normal distributions of daily intakes and requirements. A different methodology needs to be developed for nutrients for which the requirement distribution in the population is skewed (such as the iron requirements of menstruating women) or for which the distribution of daily intakes is skewed (as in the case of vitamin A, vitamin B12, vitamin C, vitamin E, and perhaps several others). Until these new methods are available, individual assessment for these nutrients should continue to place emphasis on the types of information mentioned above for a qualitative assessment.

INTRODUCTION

When an Estimated Average Requirement (EAR) for a nutrient is available, it is possible to make a quantitative assessment of the adequacy of the individual's usual intake of the nutrient. When an Adequate Intake (AI) is all that is available, it is still possible to determine whether the individual's usual intake is above the AI with a predetermined level of confidence. No conclusions can be drawn, however, when usual intake is below the AI. In this chapter, guidance is provided on how to determine whether an individual's usual intake of a nutrient exceeds the Tolerable Upper Intake Level (UL), suggesting that the usual intake is excessive. Note that use of the Recommended Dietary Allowance (RDA) is not recommended for individual assessment.

Whether one is interested in assessing the adequacy of the individual 's usual intake or in deciding whether usual intake exceeds the UL, the relevant information must include both the observed mean intake and the standard deviation (SD) of daily intakes for the individual. In the next section it is emphasized that usual intake is unobservable in practice, but for the purposes of assessment, it suffices to observe the individual 's daily intake over a few days and to have a reliable estimate of the SD of daily intake.

PROPOSED NEW METHOD FOR INDIVIDUAL ASSESSMENT

Is an individual's diet meeting nutrient needs? This question is fundamental to individual nutrition counseling and education. Answering this question is not an exact science, and the answer is considerably less precise than might be anticipated, especially because of the appearance of accuracy in computer printouts providing nutrient analysis of dietary intake data.

The Dietary Reference Intakes (DRIs) can be used to assess the

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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)