GLOBAL
HARMONIZATION
OF
METHODOLOGICAL
APPROACHES
TO
NUTRIENT INTAKE
RECOMMENDATIONS
PROCEEDINGS OF A WORKSHOP
Leslie Pray and Ann L. Yaktine, Rapporteurs
Food and Nutrition Board
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by a contract between the National Academy of Sciences and the Bill & Melinda Gates Foundation (#10003263). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-47200-5
International Standard Book Number-10: 0-309-47200-8
Digital Object Identifier: https://doi.org/10.17226/25023
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2018. Global harmonization of methodological approaches to nutrient intake recommendations: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25023.
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PLANNING COMMITTEE ON THE GLOBAL HARMONIZATION OF METHODOLOGICAL APPROACHES TO NUTRIENT INTAKE RECOMMENDATIONS1
STEPHANIE ATKINSON (Chair), Professor and Nutrition Clinician-Scientist, Department of Pediatrics, McMaster University
ROSALIND GIBSON, Professor Emerita, Department of Human Nutrition, University of Otago
ANURA KURPAD, Professor and Head, Department of Physiology and Nutrition, St. John’s Medical College
SUZANNE MURPHY, Professor Emerita and Researcher, Epidemiology Program, University of Hawaii Cancer Center
JOHN MUYONGA, Professor, Department of Food Technology and Human Nutrition, Makerere University
HEE YOUNG PAIK, Director, Center for Gendered Innovations in Science and Technology Research, Korea Federation of Women’s Science and Technology Associations
ANN PRENTICE, Director and Head, Nutrition and Bone Health Research, Medical Research Council Elsie Widdowson Laboratory, University of Cambridge
STANLEY ZLOTKIN, Professor, Pediatrics and Nutritional Sciences, Hospital for Sick Children, University of Toronto
Health and Medicine Division Staff
ANN L. YAKTINE, Study Director
AMANDA NGUYEN, Associate Program Officer
MEREDITH YOUNG, Senior Program Assistant
ANN L. YAKTINE, Director, Food and Nutrition Board
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
CELINE DUMAS, European Food Safety Authority
VALERIE FRIESEN, Global Alliance for Improved Nutrition
ALICE LICHTENSTEIN, Jean Mayer-U.S. Department of Agriculture (USDA) Human Nutrition Research Center on Aging
SIMIN MEYDANI, Jean Mayer-USDA Human Nutrition Research Center on Aging
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DIANE BIRT, Iowa State University. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Contents
Defining the Problem: Partner Panel
Organization of This Proceedings
Harmonizing the Nutrient Intake Values: Phase 1
Applications and Uses of Nutrient Intake Recommendations
Framework Consultation Process: Key Issues and Conclusions
Endpoints: Differences When Considering Deficiency Versus Chronic Disease
4 CURRENT MODELS FOR ESTABLISHING INTAKE RECOMMENDATIONS
Dietary Reference Intakes: Harmonized Nutrient Standards for Canada and the United States
South Australia and New Zealand
South Korea: 2015 Dietary Reference Intakes for Koreans
5 EXPLORING APPROACHES TO EVALUATING THE EVIDENCE
Tools for Evaluating Strength and Quality of Evidence
Global Systematic Reviews: How Can It Be Done?
Risk–Benefit Assessment of Foods in a European Perspective
6 CONTEXTUAL FACTORS: HOST, DIET/ENVIRONMENT, AND HEALTH STATUS
The Role of the Host: Genetic Variation
The Role of the Host: Physiology Adaptation
The Role of Health Status: Infection
The Role of Health Status: Aging
The Role of Diet on Nutrient Bioavailability: Issues for Habitual Diets of Asian Countries
7 BREAKOUT DISCUSSIONS: APPLICATIONS, FACILITATING QUALITY, AND COST-EFFECTIVENESS
Question 1: Advantages of Global Harmonization of Methodologies
Question 2: Additional Resources and Expertise to Facilitate Adoption of a Harmonized Approach
Question 3: Likely Barriers and Challenges to Achieving Global Harmonization
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Boxes, Figures, and Table
BOXES
2-1 Overview of Points Presented by Individual Speakers
3-1 Overview of Points Presented by Individual Speakers
4-1 Overview of Points Presented by Individual Speakers
5-1 Overview of Points Presented by Individual Speakers
6-1 Overview of Points Presented by Individual Speakers
8-1 Overview of Points Presented by Individual Speakers
FIGURES
2-2 Risk of inadequacy and risk of excess as a function of observed level of intake
Acronyms and Abbreviations
ADI | acceptable daily intake |
AHRQ | Agency for Healthcare Research and Quality |
AI | adequate intake |
AMDR | acceptable macronutrient distribution range |
ANR | average nutrient requirement |
BMI | body mass index |
BMR | basal metabolic rate |
CACFP | Child and Adult Care Food Program |
CCHS | Canadian Community Health Survey |
CNV | copy number variant |
CV | coefficient of variation |
DALY | disability-adjusted life year |
DEXA | dual-energy X-ray absorptiometry |
DFE | dietary folate equivalent |
DRI | Dietary Reference Intake |
DRV | dietary reference value |
EAR | estimated average requirement |
EFSA | European Food Safety Authority |
EPC | Evidence-based Practice Center |
EU | European Union |
EURRECA | European Micronutrient Recommendations Aligned |
FAO | Food and Agriculture Organization |
FNB | Food and Nutrition Board |
GEMS | Global Environment Monitoring System |
GIFT | Global Individual Food consumption data Tool |
GRADE | Grading of Recommendations Assessment, Development and Evaluation |
HMD | Health and Medicine Division |
ICN2 | Second International Conference on Nutrition |
ILSI | International Life Sciences Institute |
INFOODS | International Network of Food Data Systems |
INL | individual nutrient level |
IOM | Institute of Medicine |
IUNS | International Union of Nutritional Sciences |
IZiNCG | International Zinc Nutrition Consultative Group |
JAMA | Journal of the American Medical Association |
JPI | Joint Programming Initiative |
KNS | Korean Nutrition Society |
KRDA | Korean recommended dietary allowance |
LDL | low-density lipoprotein |
LOAEL | lowest-observed-adverse-effect-level |
LRNI | lower reference nutrient intake |
NFCS | Nationwide Food Consumption Survey |
NHANES | National Health and Nutrition Examination Survey |
NHMRC | National Health and Medical Research Council |
NIV | nutrient intake value |
NOAEL | no-observed-adverse-effect-level |
NOFA | nutrients and other food substances |
NRV | nutrient reference value |
PICOS | population, interventions/exposures, comparators, and outcomes of interest |
PUFA | polyunsaturated fatty acid |
QAI | quality assessment instrument |
RBC | red blood cell |
RCT | randomized controlled trial |
RDA | recommended dietary allowance |
RIVM | Netherlands National Institute for Public Health and the Environment |
RNI | reference nutrient intake |
SCF | Scientific Committee on Food |
SNAP | Supplemental Nutrition Assistance Program |
SNP | single nucleotide polymorphism |
SRDR | Systematic Review Data Repository |
UK | United Kingdom |
UL | tolerable upper intake level |
UN | United Nations |
UNICEF | United Nations Children’s Fund |
UNL | upper nutrient level |
USDA | U.S. Department of Agriculture |
UV | ultraviolet |
WHO | World Health Organization |
WIC | Supplemental Nutrition Program for Women, Infants, and Children |
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