Part 4: Moving Forward

Garnering Support Across Countries

In order to move forward toward implementing the process of harmonized methodologies used to set nutrient reference values (NRVs), requires a complex array of actions, which include but are not limited to the following:

• Encourage regional and international working groups and partnerships.
• Provide leadership in establishing regional and international NRVs; ideally a global authoritative body, such as the World Health Organization (WHO) and/or the Food and Agriculture Organization of the United Nations (FAO).
• Continue to promote the harmonization model and its importance to national and international audiences.
• Identify local, national, or international conveners to support NRV initiatives.
• Create a detailed list of local or regional factors that could influence NRVs and subsequent adjustments needed (i.e., bioavailability and other biomarkers of nutrient status).
• List common polymorphisms that could influence specific NRVs within a population or region.
• Create forms and operating procedures that can be adapted to the unique conditions of a country or region.

Identifying Pathways to Support Implementation

Global Harmonization of Approaches to Nutrient Reference Values: Proceedings of a Workshop (NASEM, 2018a) described a model for harmonizing the approach to deriving NRVs globally. Moving forward toward implementation will require dialogue across countries to gain support for the harmonization effort as well as participation and investment from groups and organizations to whom global harmonization will be entrusted. The collective efforts of global organizations such as WHO/FAO, nongovernmental stakeholder organizations and foundations at the regional level; and country-level agencies such as in the United States and European countries is needed to launch an initiative that will advocate for implementation. Following are specific steps that can be taken as part of implementation and communication efforts globally.

• Create and maintain a centralized nutrition evidence library of scientific publications regarding nutrient requirements.
• Create and maintain a library with all of the recent past and current nutrient reference values from countries, regions, and global groups.

• Create databases of systematic reviews that identify key factors that need to be addressed when establishing NRVs, and the literature used to support selection of values.
• Establish a repository of the tools needed to establish NRVs through an international organization (i.e., WHO/FAO) or a secretariat or stakeholder at the regional level.
• Establish and maintain key references regarding NRVs from expert groups (e.g., IZiNCG, Global Iodine Network, etc.).

In conclusion, the need for harmonization of the NRV process is clear, as is the need for users to have access to adequate requirement and tolerable upper intake level values. Much work has already been done to describe how this should be achieved, and this tool kit provides a practical summary of the most important steps needed. Additionally, the tool kit recognizes that the costs of revising or establishing new NRVs may be prohibitive and describes ways to build on existing work and databases to reduce time and costs. National, regional, and international leadership is now needed to implement the process.