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

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. "Summary." 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

individual's usual intake.

  • There is day-to-day variation in intake for an individual. The within-person standard deviation of intakes is an indicator of how much observed intake may deviate from usual intake.

Inferences about the adequacy of an individual's diet can be made by looking at the difference between observed intake and the median requirement. If this difference is large and positive, that is, if observed intake is much greater than the median requirement, then it is likely that an individual's intake is adequate. Conversely, if the difference is large and negative, that is, observed intake is much less than the median requirement, then it is likely that an individual's intake is not adequate. In between there is considerable uncertainty about the adequacy of the individual's intake.

For practical purposes, many users of the DRIs may find it useful to consider that observed intakes below the EAR very likely need to be improved (because the probability of adequacy is 50 percent or less), and those between the EAR and the Recommended Dietary Allowance (RDA) probably need to be improved (because the probability of adequacy is less than 97 to 98 percent). Only if intakes have been observed for a large number of days and are at or above the RDA, or observed intakes for fewer days are well above the RDA, should one have a high level of confidence that the intake is adequate. It is hoped that computer software will be developed that will determine these probabilities (as described in Appendix B), thus offering more objective alternatives when individual intakes are evaluated.

Using the AI to Assess Individuals

Some nutrients have an Adequate Intake (AI) because the evidence was not sufficient to establish an EAR and thus an RDA for the nutrient in question. The approach described above for the EAR cannot be used for nutrients that have an AI. However, a statistically based hypothesis testing procedure for comparing observed intake to the AI may be used. This is a simple z-test, which is constructed using the standard deviation of daily intake of the nutrient.

What conclusions can be drawn about the adequacy of individual intakes for nutrients with AIs? First, if an individual's usual intake equals or exceeds the AI, it can be concluded that the diet is almost certainly adequate. If, however, their intake falls below the AI, no quantitative (or qualitative) estimate can be made of the probability of nutrient inadequacy. Professional judgment, based on additional

Page
6
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)