Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease (2017) / Chapter Skim
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1 Introduction
1 Introduction
Pages 19-38
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recently summarized the "long road leading to the Dietary Reference Intakes for the United States and Canada" (Murphy et al., 2016)
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In 1983, the Recommended Nutrient Intakes replaced the RDAs in Canada, and in the mid-1990s, the Dietary Reference Intakes (DRIs) replaced the RDAs in the United States.
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. RATIONALE FOR SETTING CHRONIC DISEASE DIETARY REFERENCE INTAKES Although nutrient deficiencies are still widespread at a global level, they are less common in the western world and the United States in particular.
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. Today, an even more challenging health problem than nutrient deficiency diseases is chronic diseases.4 It is estimated that chronic diseases are responsible for 70 percent of all deaths globally.
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recognized that considering chronic diseases raised new challenges and questions for DRI committees, requiring a special focus and specifically oriented guidance. From there, a consensus emerged that a common understanding of the challenges was needed, as were recommendations and guiding principles to drive the activities and approaches of future DRI committees.
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STATEMENT OF TASK The statement of task for the current study (see Box 1-1) requests that the committee assess the options presented in the Options Report and determine guiding principles for including chronic disease endpoints for food substances5 that will be used by future National Academies committees in establishing Dietary Reference Intakes (DRIs)
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: Summary Report from a Joint US-/ Canadian-sponsored Expert Panel (i.e., the Options Report) and determine guid ing principles for the inclusion of chronic disease endpoints for food substances that will be used by future National Academies committees in establishing Di etary Reference Intakes (DRIs)
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Experts were drawn from a broad range of disciplines, including human nutrition, toxicology, biostatistics, major diet-related chronic diseases, preventive medicine, study quality assessment, research methodology, epidemiology, and use of DRIs. Three of the members were among the authors of the Options Report.
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The intent of this report is not to change the core DRI process but to provide a degree of consistency and transparency in the approach to making decisions when the process of considering chronic disease endpoints for establishing DRIs is conducted. Therefore, the committee offered its recommendations and guiding principles in the context of the process shown in Figure 1-2, which illustrates actors and selected tasks.
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a The Agency for Healthcare Research and Quality is listed here as the agency that, in the current DRI process, has been respon TEP = Technical Expert Panel; DRI = Dietary Reference Intake; AHRQ = Agency for Health Care Research and Quality; SR = Systematic Review sible for the systematic review aspects of DRI development. b National Academies DRI committees are convened by and positioned with the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine and operate under the National Academies study committee guidelines, which include an external peer review process of the draft DRI report.
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Although DRI committees should be sensitive to risk management considerations, risk management decisions are not the purview of DRI committees. Also, as shown in Figure 1-2, the committee suggests continuation of the practice started with the 2011 DRIs for calcium and vitamin D, in which formal systematic reviews were conducted by an outside contractor (e.g., an Agency for Healthcare Research and Quality Evidence-based Practice Center)
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The committee generally agrees that the guiding principles in this report apply to the "apparently healthy population." However, because "apparently healthy population" potentially encompasses a diverse group of individuals with many different health conditions, the committee also highlights the need for DRI committees to characterize the health status of the population in terms of who is included and excluded for each DRI. Specifically, based on the committee's interpretation of the statement of task, the committee recognizes (1)
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Because a well-conducted systematic review is essential, this report includes guiding principles related to selected aspects of conducting scientifically rigorous systematic reviews, such as the systematic review protocol.
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. Therefore, for greatest value and effectiveness of the process, some of the recommendations and guiding principles might need to be considered by the systematic review team, the sponsors or others, as they develop the protocol and tasks for DRI committees.
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What is the objective of the guiding principles for establishing DRIs based on chronic disease? What is the task and what subjects are outside of the task?
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How might these challenges affect the certainty of judgments about evidence about causal or intake response relationships between NOFSs and chronic diseases? 4: Methodological How should use of N/A Considerations biomarkers of intake and Related to Assessing self-report dietary intake Intake of Nutrients methodologies influence of Other Food ratings of study quality?
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Specifying Intake-Response Disease Relations: Qualified Surrogate What tools, approaches, or Disease Markers and instruments should be used Nonqualified Disease Markers to assess the certainty of the • Extrapolating Intake-Response evidence in the data for an Data intake-response relationship • Different Types of Reference between an NOFS and a Values: Types of Reference chronic disease? Values Associated with Benefit • Different Types of Reference Values: ULs and Reduction in Chronic Disease Risk • Acceptable Level of Confidence in the Intake-Response Data • Overlaps Between Benefits and Harms 8: The Process for How should the new DRI OPTIONS FOR THE NEW DRI Establishing Chronic process be integrated PROCESS Disease Dietary into the current process • Process Components and Reference Intakes of establishing DRIs for Options adequacy and toxicity?
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2003. Dietary Reference Intakes: Guiding principles for nutrition labeling and fortifica tion.
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6 Note: Adapted from the DRI Organizing Framework as described in the 2011 Institute of Medicine report Dietary Reference Intakes for Calcium and Vitamin D (IOM, 2011b, pp.
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Step 4: Discussion of Implications and Special Concerns Characterization of the implications and special concerns is a hallmark of the organizing framework. For DRI purposes, it includes an integrated discussion of the public health implications of the DRIs and how the reference values may need to be adjusted for special vulnerable groups within the normal population.
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