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Suggested Citation:"Front Matter." 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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DRI DIETARY REFERENCE INTAKES

Applications in Dietary Assessment

A Report of the

Subcommittee on Interpretation and Uses of Dietary Reference Intakes

and the

Standing Committee on the Scientific Evaluation of Dietary Reference Intakes

Food and Nutrition Board

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by Health Canada; U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion, Contract No. 282-96-0033; the Dietary Reference Intakes Private Foundation Fund, including the Dannon Institute and the International Life Sciences Institute; and the Dietary Reference Intakes Corporate Donors' Fund. Contributors to the Fund to date include Daiichi Fine Chemicals, Inc.; Kemin Foods, L.C.; M&M/Mars; Mead Johnson Nutritionals; Nabisco Foods Group; Natural Source Vitamin E Association; Roche Vitamins Inc.; U.S. Borax; and Weider Nutritional Group. The opinions or conclusions expressed herein are those of the committee and do not necessarily reflect those of the funders.

Library of Congress Cataloging-in-Publication Data

Dietary reference intakes. Applications in dietary assessment : a report of the Subcommittees on Interpretation and Uses of Dietary Reference Intakes and Upper Reference Levels of Nutrients, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine.

p. ; cm.

Includes bibliographical references and index.

ISBN 0-309-07311-1 (hardcover) — ISBN 0-309-07183-6 (pbk.)

1. Nutrition. 2. Reference values (Medicine) 3. Nutrition—Evaluation. I. Title: Applications in dietary assessment. II. Institute of Medicine (U.S.). Subcommittee on Interpretation and Uses of Dietary Reference Intakes. III. Institute of Medicine (U.S.). Subcommittee on Upper Reference Levels of Nutrients. IV. Institute of Medicine (U.S.). Standing Committee on the Scientific Evaluation of Dietary Reference Intakes.

[DNLM: 1. Nutrition Assessment. 2. Dietetics. 3. Nutrition Policy. 4. Nutritional Requirements. QU 146 D5656 2001]

QP141 D525 2001

613.2—dc21

00-069187

This report is available for sale from the

National Academy Press,
2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055; call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's on-line bookstore at http://www.nap.edu.

For more information about the Institute of Medicine or the Food and Nutrition Board, visit the IOM home page at http://www.iom.edu.

Copyright 2000 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

“Knowing is not enough; we must apply. Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE

Shaping the Future for Health

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

THE NATIONAL ACADEMIES

National Academy of Sciences

National Academy of Engineering

Institute of Medicine

National Research Council

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

Suggested Citation:"Front Matter." 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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SUBCOMMITTEE ON INTERPRETATION AND USES OF DIETARY REFERENCE INTAKES

SUZANNE P. MURPHY (Chair),

Cancer Research Center of Hawaii, University of Hawaii, Honolulu

LENORE ARAB,

Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill

SUSAN I. BARR, Faculty of Agricultural Sciences,

University of British Columbia, Vancouver

SUSAN T. BORRA,

International Food Information Council, Washington, D.C.

ALICIA L. CARRIQUIRY,

Department of Statistics, Iowa State University, Ames

BARBARA L. DEVANEY,

Mathematica Policy Research, Princeton, New Jersey

JOHANNA T. DWYER,

Frances Stern Nutrition Center, New England Medical Center and Tufts University, Boston, Massachusetts

JEAN-PIERRE HABICHT,

Division of Nutritional Sciences, Cornell University, Ithaca, New York

JANET C. KING,*

USDA Western Human Nutrition Research Center, University of California, Davis

HARRIET V. KUHNLEIN,

Centre for Indigenous Peoples' Nutrition and Environment, McGill University, Ste. Anne de Bellevue, Quebec

Consultant

GEORGE BEATON,

GHB Consulting, Willowdale, Ontario

Staff

Mary Poos, Study Director

Alice L. Vorosmarti, Research Associate

Michele Ramsey, Senior Project Assistant

Karah Nazor, Project Assistant

*

Term of Service

February 17, 1998, to June 30, 1999

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

SUBCOMMITTEE ON UPPER REFERENCE LEVELS OF NUTRIENTS

IAN C. MUNRO (Chair),

CanTox, Inc., Mississauga, Ontario

GEORGE C. BECKING,

Phoenix OHC, Kingston, Ontario

RENATE D. KIMBROUGH,

Institute for Evaluating Health Risks, Washington, D.C.

RITA B. MESSING,

Division of Environmental Health, Minnesota Department of Health, St. Paul

SANFORD A. MILLER,

Graduate School of Biomedical Sciences, University of Texas Health Sciences Center, San Antonio

HARRIS PASTIDES,

School of Public Health, University of South Carolina, Columbia

JOSEPH V. RODRICKS,

The Life Sciences Consultancy LLC, Washington, D.C.

IRWIN H. ROSENBERG,

Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts

STEVE L. TAYLOR,

Food Processing Center, University of Nebraska-Lincoln

JOHN A. THOMAS, Professor Emeritus,

University of Texas Health Science Center at San Antonio

GARY M. WILLIAMS,

Department of Pathology, New York Medical College, Valhalla, New York

Staff

Sandra Schlicker, Study Director

Michele Ramsey, Senior Project Assistant

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

STANDING COMMITTEE ON THE SCIENTIFIC EVALUATION OF DIETARY REFERENCE INTAKES

VERNON R. YOUNG (Chair),

Laboratory of Human Nutrition, School of Science, Massachusetts Institute of Technology, Cambridge

JOHN W. ERDMAN, JR. (Vice-Chair),

Division of Nutritional Sciences, College of Agricultural, Consumer and Environmental Sciences, University of Illinois at Urbana-Champaign

LINDSAY H. ALLEN,

Department of Nutrition, University of California, Davis

STEPHANIE A. ATKINSON,

Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario

ROBERT J. COUSINS,

Center for Nutritional Sciences, University of Florida, Gainesville

JOHANNA T. DWYER,

Frances Stern Nutrition Center, New England Medical Center and Tufts University, Boston, Massachusetts

JOHN D. FERNSTROM,

UPMC Health System Weight Management Center, University of Pittsburgh School of Medicine, Pennsylvania

SCOTT M. GRUNDY,

Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas

JANET C. KING,*

USDA Western Human Nutrition Research Center, University of California, Davis

SANFORD A. MILLER,

Graduate School of Biomedical Sciences, University of Texas Health Sciences Center, San Antonio

WILLIAM M. RAND,

Department of Family Medicine and Community Health, Tufts University School of Medicine, Boston, Massachusetts

U.S. Government Liaison

ELIZABETH CASTRO,

Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Washington, D.C.

*

Term of Service

December 12, 1997, to June 30, 1999

Page viii Cite
Suggested Citation:"Front Matter." 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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Canadian Government Liaison

PETER W.F. FISCHER,

Nutrition Research Division, Health Protection Branch, Health Canada, Ottawa, Ontario

Staff

Allison A. Yates, Study Director

Gail E. Spears, Administrative Assistant

Mary Poos, Senior Program Officer

Sandra Schlicker, Senior Program Officer

Paula Trumbo, Senior Program Officer

Alice L. Vorosmarti, Research Associate

Kimberly Freitag, Research Assistant

Michele Ramsey, Senior Project Assistant

Suggested Citation:"Front Matter." 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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FOOD AND NUTRITION BOARD

CUTBERTO GARZA (Chair),

Division of Nutritional Science, Cornell University, Ithaca, New York

ALFRED H. MERRILL, JR. (Vice Chair),

Center for Nutrition and Health Sciences, Emory University, Atlanta, Georgia

ROBERT M. RUSSELL (Vice Chair),

Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts

VIRGINIA A. STALLINGS (Vice Chair),

Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania

LARRY R. BEUCHAT,

Center for Food Safety and Quality Enhancement, University of Georgia, Griffin

BENJAMIN CABALLERO,

Center for Human Nutrition, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland

FERGUS M. CLYDESDALE,

Department of Food Science, University of Massachusetts at Amherst

ROBERT J. COUSINS,

Center for Nutritional Sciences, University of Florida, Gainesville

SCOTT M. GRUNDY,

Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas

LYNN PARKER,

Child Nutrition Programs and Nutrition Policy, Food Research and Action Center, Washington, D.C.

ROSS L. PRENTICE,

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington

A. CATHARINE ROSS,

Department of Nutrition, The Pennsylvania State University, University Park

ROBERT E. SMITH,

R.E. Smith Consulting, Inc., Newport, Vermont

STEVE L. TAYLOR,

Food Processing Center, University of Nebraska-Lincoln

Staff

Allison A. Yates, Director

Gail E. Spears, Administrative Assistant

Gary Walker, Financial Associate

Suggested Citation:"Front Matter." 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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Suggested Citation:"Front Matter." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

Preface

This report is one of a series that relates to the development of Dietary Reference Intakes. This report focuses on applications of Dietary Reference Intakes (DRIs) in dietary assessment from the Subcommittee on Interpretation and Uses of Dietary Reference Intakes (Uses Subcommittee) of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes (DRI Committee). A forthcoming report from this Subcommittee will address applications of DRIs in dietary planning.

The Food and Nutrition Board anticipated that considerable guidance would be needed to assist American and Canadian health professionals in the transition from using the former Recommended Dietary Allowances (RDAs) for the United States and Recommended Nutrient Intakes (RNIs) for Canada to using the new DRIs, and thus charged the DRI Committee and the Uses Subcommittee to develop advice on the appropriate uses of these new references.

In the past, RDAs and RNIs were the primary values that were available to health professionals for planning and assessing the diets of individuals and groups. However, the former RDAs and RNIs were not ideally suited for many of these applications. The new DRIs represent a more complete set of values that were developed anticipating diverse uses for planning and/or assessment and thus allow more robust approaches. To assist health professionals in their use of the new DRIs, the Uses Subcommittee divided its work into two parts: the current report examines the appropriate use of each of the available DRI values in assessing nutrient intakes of groups and of individuals and a second report will present informa-

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

tion on the appropriate use of specific DRI values in the planning of diets for groups and for individuals. Each report will present the statistical underpinnings for the various uses of the DRI values, present sample applications, and provide guidelines to help professionals determine when specific uses are inappropriate.

A probability approach to assessing prevalence of nutrient inadequacy in groups was developed and presented—with extensive statistical validation and identification of sources of error—in the National Research Council Report, Nutrient Adequacy (NRC, 1986). The availability of Estimated Average Requirements (EARs), one of the categories of DRIs, makes the use of the probability approach possible. A modified approach, using the Estimated Average Requirement (EAR) as a cutpoint for assessing the prevalence of nutrient inadequacy in groups, is presented in this report. The cut-point method, however, is not a new independent approach; it is a modification of the probability approach. The statistical validation of the EAR cutpoint method to assess prevalence of inadequacy in groups is presented in this report.

When the initial plan to revise the former RDAs was published (IOM, 1994), the Food and Nutrition Board envisioned the simultaneous establishment of the DRI Committee and two standing subcommittees, the Subcommittee on Upper Reference Intake Levels of Nutrients and the Uses Subcommittee. However, circumstances precluded the early convening of the Uses Subcommittee. It was not established until early 1998, after the release of the first two nutrient reports (IOM, 1997, 1998b).

The Uses Subcommittee, with expertise in nutrition, dietetics, statistics, nutritional epidemiology, public health, economics, and consumer perspectives, was charged to review the scientific literature regarding the uses of dietary reference standards and their applications, and to provide guidance for (1) the appropriate application of DRIs for specific purposes and identification of inappropriate applications, (2) appropriate assumptions regarding intake and requirement distributions, (3) adjustments needed to minimize potential errors in dietary intake data, and (4) appropriate use of DRI values of specific nutrients. Starting with the report of the Panel on Dietary Antioxidants and Related Compounds, this specific guidance will be found in the nutrient reports.

This report reflects the work of the Food and Nutrition Board's DRI Committee, the Uses Subcommittee, and the Subcommittee on Upper Reference Levels of Nutrients. The support of the government of Canada and Canadian scientists in establishing the Uses Subcommittee represents a pioneering first step in the standardiza-

Page xiii Cite
Suggested Citation:"Front Matter." 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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tion of nutrient reference intakes in North America. A brief description of the overall DRI project is given in Appendix A.

This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review was to provide candid and critical comments to assist the authors and the Institute of Medicine in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The contents of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We wish to thank the following individuals for their participation in the review of this report: Cynthia M. Beall, Ph.D., Case Western Reserve University; William H. Danforth, M.D., Washington University; Mary J. Kretsch, Ph.D., RD, U.S. Department of Agriculture; George P. McCabe, Ph.D., Purdue University; Grace L. Ostenso, Ph.D., Washington, D.C.; Eric B. Rimm, Sc.D., Harvard School of Public Health; Christopher P. Sempos. Ph.D., State University of New York; Helen Smiciklas-Wright, Ph.D., RD, Pennsylvania State University; Paul D. Stolley, M.D., MPH, University of Maryland at Baltimore; and Valerie Tarasuk, Ph.D., University of Toronto.

Although the individuals listed above provided many constructive comments and suggestions, responsibility for the final content of this report rests solely with the authoring committee and the Institute of Medicine.

The DRI Committee wishes to acknowledge, in particular, the commitment and dedication shown by Suzanne P. Murphy, chair of the Uses Subcommittee. Dr. Murphy's expertise and direction were key to the resolution of controversial issues and to the presentation of technically complex information and its statistical basis in a clear and readily understandable manner. Sincere thanks are also extended to George H. Beaton for his willingness to participate as a technical consultant to the Uses Subcommittee. His provocative comments and assistance provided an important impetus to move the conceptual framework, while still in development and far from complete, forward. Not all issues have been resolved, but the foundation has been initiated. We also extend special thanks to the staff of the Food and Nutrition Board and especially to Mary Poos, study director for the Uses Subcommittee, for her many contributions to the synthesis of the report. We recognize the significant efforts of the Subcommittee and the Food and Nutrition Board staff that were required to achieve the completion of this report. It is, of course,

Suggested Citation:"Front Matter." Institute of Medicine. 2000. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, DC: The National Academies Press. doi: 10.17226/9956.
×

the Food and Nutrition Board staff who get much of the work completed, so on behalf of the DRI Committee and the Board, we wish to thank Allison Yates, Director of the Food and Nutrition Board and study director for the DRI activity, for her continued oversight, and also recognize, with appreciation, the contributions of Michele Ramsey, Alice Vorosmarti, Karah Nazor, Sandra Schlicker, and Gail Spears. We wish also to thank Carol Suitor for scientific and organizational review, Judith Dickson for editing the manuscript, and Mike Edington and Claudia Carl for assistance with its publication.

Vernon Young

Chair, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes

Cutberto Garza

Chair, Food and Nutrition Board

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Next: Contents »
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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