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Dietary DRI Reference Intakes
PREFACE iii Dietary DRI Reference Intakes The Essential Guide to Nutrient Requirements Jennifer J. Otten, Jennifer Pitzi Hellwig, Linda D. Meyers, Editors THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 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 Insti- tute of Medicine. This project was supported by Contract No. 4500096095 between the National Acad- emy of Sciences and Health Canada and by the National Research Council. Any opin- ions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Dietary reference intakes : the essential guide to nutrient requirements / Jennifer J. Otten, Jennifer Pitzi Hellwig, Linda D. Meyers, editors. p. cm. Includes bibliographical references and index. ISBN 0-309-10091-7 (hardback) â ISBN 0-309-65646-X (pdfs) 1. Nutrition. 2. NutritionâEvaluation. 3. Reference values (Medicine) I. Otten, Jennifer J. II. Hellwig, Jennifer Pitzi. III. Meyers, Linda D. QP141.D5296 2006 612.3âdc22 2006015626 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2006 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
âKnowing is not enough; we must apply. Willing is not enough; we must do.â â Goethe Advising the Nation. Improving Health.
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PREFACE vii PREFACE T his book is a selective summary of the series of publications on Dietary Reference Intakes (DRIs). Its goal is to serve as a practical, hands-on ref- erence to help guide health professionals in the United States and Canada in their day-to-day task of assessing and planning for the nutrient needs of individuals and groups of people. The book also provides educators with a tool for guiding students in the understanding of the DRI concept and use of the reference values. It is derived from work authored by the Food and Nutrition Board (FNB) of the Institute of Medicine (IOM). This book is not meant to replace the original DRI series of nutrient refer- ence values published between 1997 and 2005 nor is it intended to be a thor- ough representation of the series. Based on material from the original DRI se- ries, this book stays true to the findings and recommendations from the original reports. Without introducing new data or conclusions, this document recasts essential ideas from the original reports in an accessible and more compact form. The DRI values and paradigm replace the former Recommended Dietary Allowances (RDAs) for the United States and Recommended Nutrient Intakes (RNIs) for Canada. In the past, RDAs and RNIs were the primary values avail- able to U.S. and Canadian health professionals for planning and assessing the diets of individuals and groups. The DRIs represent a more complete set of values. They were developed in recognition of the growing and diverse uses of quantitative reference values and the availability of more sophisticated approaches for dietary planning and assessment purposes. Although all reference values in this book are based on data, available data were often sparse or drawn from studies with significant limitations in address- ing various questions confronted by the original DRI panel and subcommittees. Thus, although governed by scientific rationale, informed judgments were of- ten required in setting reference values. Where data were available, criteria of nutritional adequacy were carefully identified; these criteria are listed in tables in each nutrient chapter. Readers are urged to recognize that the DRI process is iterative in character. We expect that the DRI conceptual framework will continue to evolve and be improved as new information becomes available and is applied to an expanding list of nutrients and other food components. Thus, because the DRI activity is ongoing, comments were solicited widely and received on the originally pub- lished reports of this series. With more experience, the proposed models for
PREFACE viii establishing reference intakes of nutrients and other food components that play significant roles in promoting and sustaining health and optimal functioning will be refined. Also, as new information or new methods of analysis are adopted, these reference values undoubtedly will be reassessed. This book will be up- dated in the future as the original series is revised. This book has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Councilâs Report Review Committee. The purpose of this independent review is to provide candid, confidential, and criti- cal comments that will assist the institution in making its published book as sound as possible and to ensure that the book meets institutional standards. We wish to thank the following individuals for their review of this report: Lawrence Appel, Johns Hopkins Medical Institutions; Stephanie A. Atkinson, McMaster University; Susan I. Barr, University of British Columbia; Ann M. Coulston, Ely Lilly and Co.; John W. Erdman, University of Illinois at Urbana-Champaign; Norman I. Krinsky, Tufts University; Joanne R. Lupton, Texas A&M University; Suzanne Murphy, University of Hawaii; Roy M. Pitkin, University of California, Los Angeles; Robert M. Russell, Tufts University. Although these reviewers provided many constructive comments and sug- gestions, they were not asked to endorse nor did they see the final draft of the book before its release and publication. The review of this report was overseen by Clyde J. Behney, who was responsible for making certain that an indepen- dent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. The Institute of Medicine gratefully acknowledges Health Canadaâs sup- port and participation in this initiative. This close collaboration represents a pioneering step in the harmonization of nutrient reference intakes in North America. In particular, the Food and Nutrition Board wishes to extend special thanks to our Health Canada partners who helped refine drafts and provided invaluable comments that vastly improved the project: Mary Bush, Danielle BrulÃ©, Margaret Cheney, Krista Esslinger, Linda Greene-Finestone, and Sylvie St-Pierre. We also express our gratitude and thanks to Health Canada for per- mitting incorporation of materials on the Dietary Reference Intakes extracted from The Canadian Community Health Survey 2.2, Nutrition Focus: A Guide to Accessing and Interpreting the Data, published by Health Canada in 2006. The consultants for this projectâJohanna T. Dwyer, Rachel K. Johnson, Rena Mendelson, Esther F Myers, Sharon M. Nickols-Richardson, Linda G. . Snetselaar, Huguette Turgeon-OâBrien, and Susan Whitingâably performed their work under severe time pressures (see Appendix B for biographical sketches). All gave their time and effort willingly and without financial reward; the public and the science and practice of nutrition are among the major beneficiaries of
PREFACE ix their dedication. This project would not have been undertaken and completed without the dedicated work of the project staff, in particular, Jennifer Otten who co-wrote and managed the project and its many iterations, Jennifer Pitzi Hellwig who co-wrote and copyedited parts of the book, Mary Kalamaras who guided initial plans and copyedited a very complex and complicated manu- script, and Linda D. Meyers who oversaw the project and never hesitated to assist when help was needed. The intellectual and managerial contributions made by these individuals to the project were critical. Sincere thanks also go to other IOM and National Academies staff, including Ricky Washington, Gerri Kennedo, Ann Merchant, Virginia Bryant, Barbara Kline Pope, Estelle Miller, Will Mason, Lara Andersen, Sally Stanfield, Charles Baum, Sally Groom, Dorothy Lewis, Stephen Mautner, Marc Gold, Linda Kilroy, Anton Bandy, Gary Walker, Vivian Tillman, Bronwyn Schrecker Jamrok, Tyjen Tsai, and Sandra Amamoo- Kakra. I also want to extend my personal gratitude to the many volunteers who served the Institute of Medicine and the nation as members of the Food and Nutrition Board, members of the committees who prepared the DRI series and reviewers of the draft reports in that series. Their dedication and expertise in reviewing, interpreting, and translating scientific evidence into nutrient refer- ence values is a substantial contribution to the publicâs health. Harvey V. Fineberg, M.D., Ph.D. President, Institute of Medicine
CONTENTS xi CONTENTS INTRODUCTION 1 PART I: DEVELOPMENT AND APPLICATION 3 Introduction to the Dietary Reference Intakes, 5 Applying the Dietary Reference Intakes, 19 PART II: ENERGY, MACRONUTRIENTS, WATER, AND PHYSICAL ACTIVITY 69 Macronutrients, Healthful Diets, and Physical Activity, 70 Energy, 82 Physical Activity, 94 Dietary Carbohydrates: Sugars and Starches, 102 Fiber, 110 Dietary Fat: Total Fat and Fatty Acids, 122 Cholesterol, 140 Protein and Amino Acids, 144 Water, 156 PART III: VITAMINS AND MINERALS 167 VITAMINS Vitamin A, 170 Vitamin B6, 182 Vitamin B12, 188 Biotin, 196 Vitamin C, 202 Carotenoids, 211 Choline, 218 Vitamin D, 224 Vitamin E, 234 Folate, 244 Vitamin K, 254
CONTENTS xii Niacin, 262 Pantothenic Acid, 270 Riboflavin, 274 Thiamin, 280 MINERALS Calcium, 286 Chromium, 296 Copper, 304 Fluoride, 312 Iodine, 320 Iron, 328 Magnesium, 340 Manganese, 350 Molybdenum, 356 Phosphorus, 362 Potassium, 370 Selenium, 380 Sodium and Chloride, 386 Sulfate, 397 Zinc, 402 Arsenic, Boron, Nickel, Silicon, and Vanadium, 414 PART IV: APPENDIXES 423 A Acknowledgments 425 B Biographical Sketches 429 C Methods 435 D Glossary and Acronyms 447 E DRI Values for Indispensable Amino Acids by Life Stage and Gender Group 459 F Conversions 466 G Iron Intakes and Estimated Percentiles of the Distribution of Iron Requirements from the Continuing Survey of Food Intakes by Individuals (CSFII), 1994â1996 474 H Standard Deviation of Requirements for Nutrients with an EAR 485 I Estimates of Within-Subject Variation in Intake 487
CONTENTS xiii INDEX 493 SUMMARY TABLES 529 REFERENCES* *Full references, which also appear in the parent report series, the Dietary Reference Intakes, are not printed in this book but are provided online at http://www.nap.edu/ catalog/11537.html.