Harmonization of Methods for Setting Nutrient Reference Values: A Tool Kit
Harmonized approaches to setting recommendations for safe and appropriate dietary intakes and nutritional interventions are critical to:
- Support the resolution of differences across countries in setting national and international nutrition standards;
- Promote consistency in public and clinical health objectives;
- Provide a mechanism for designing national and international food and nutrition policies; and
- Enhance the transparency of national standards for trade and other regulatory actions that have economic, health, and safety implications.
Consistent dietary intake recommendations cannot be made without first establishing a consistent approach to derive reference values for population-level nutrient intakes.
This tool kit is designed to help global stakeholders, including those in low- and middle-income countries, participate more easily in the process of implementing, disseminating, and evaluating a consistent and homogeneous methodological approach to the nutrient reference value (NRV) process.
Developing new NRVs is a lengthy and resource-intensive process, but it is often possible to adopt or adapt existing NRVs to local contexts. This tool kit assists users in the process of deciding which approach—adapting existing NRVs or establishing new NRVs—is best, and how to carry out that decision. The tool kit also identifies resources that can make the process more efficient. Because the commitment of stakeholders to NRV development—and their active engagement in the process—is essential to the success of nutrient intake recommendations, the tool kit also includes a section on facilitating dialogue and engagement to foster further harmonization efforts.
Content and Structure of This Tool Kit
Part 1: Background on Nutrient Reference Values
This section of the tool kit explains early work to develop NRVs and how the Bill & Melinda Gates Foundation, the World Health Organization (WHO), and the Food and Agriculture Organization of the United Nations (FAO) contributed to activities undertaken to advance this process globally. These activities included the 2017 Global Harmonization of Methodological Approaches to Nutrient Intake Recommendations workshop and the 2018 consensus report, Harmonization of Approaches to Nutrient Reference Values: Applications to Young Children and Women of Reproductive Age (see References).
The proceedings of a workshop and the consensus study report provide much of the material that underpins this tool kit.
Part 2: A Conceptual Foundation for Developing Nutrient Reference Values
This section of the tool kit provides a foundation to support the process of deriving NRVs by first defining the core NRVs and then outlining key principles to guide the process for setting those values. It also describes the current process that many countries use to derive NRVs.
Part 3: Developing a Harmonized Process for Deriving Nutrient Reference Values
Part 3 provides guidance to countries as they undertake the process of setting NRVs, either by adapting or updating existing values or by establishing new values. A framework is presented to guide the process that countries will use to determine the two primary NRVs—average requirement (AR) and tolerable upper intake level (UL).
Following the elements of the framework, it provides information and resources on:
- Choosing key tools and data resources.
- Collecting data from the tools and data resources.
- Identifying the best approaches for the nutrients being considered, and
- Deriving the AR and UL values for those nutrients.
Part 4: Moving Forward
Ensuring that stakeholders support and are engaged in the process of setting NRVs is essential to this task. This section discusses ways in which organizations and agencies involved in setting harmonized NRVs can garner support across countries and identify pathways for implementation.
