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Redesigning the Process for Establishing the Dietary Guidelines for Americans (2017) / Chapter Skim
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Appendix E: Additional Information About the Dietary Reference Intakes
Pages 243-252

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From page 243...
... Given the interface between the DRIs and the DGA, the sections that follow provide context by presenting a historical perspective on the DRIs, outlining how the DRIs are intended to be used to assess nutritional adequacy and excesses, and describing the extent to which chronic disease end points have informed the DRIs. A HISTORICAL PERSPECTIVE ON THE DIETARY REFERENCE INTAKES Between 1941 and 1994, the Food and Nutrition Board (FNB)
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From page 244...
... . RDA values were based, in large part, on prevention of the deficiency disease associated with lack of the specific essential nutrient, plus a margin of safety above this number to ensure good nutrition and protect all body tissues, termed "nutritional adequacy." Canada had a parallel process that produced values called Recommended Nutrient Intakes (RNIs)
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From page 245...
... . In addition to setting the values for determining nutrient adequacy, a new emphasis for the reference intakes was chronic disease prevention in apparently healthy populations.
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From page 246...
... The EAR cut-point method is a shortcut to the probability approach and is performed by determining the proportion of the group with intakes below the EAR. This method typically provides similar results to the probability approach, and works particularly well when intakes are accurately measured, actual prevalence in the group is neither very low nor very high, estimated usual intakes of individuals are inde pendent of each individual's requirements, the distribution of require ments is approximately symmetrical, and variability in intakes among individuals in the group is greater than the variability in requirements of the individual.
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From page 247...
... . ASSESSING RISK CAUSED BY EXCESSIVE INTAKES USING DIETARY REFERENCE INTAKE VALUES The Tolerable Upper Intake Level (UL)
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From page 248...
... 248 REDESIGNING THE PROCESS FOR ESTABLISHING THE DGA TABLE E-1  Critical Adverse Effects Used to Establish Tolerable Upper Intake Levels in the Dietary Reference Intakes Nutrient Critical Adverse Effect Used to Establish Tolerable Upper Level Borona Reproductive and developmental effectsb,c Calcium Calcium excretion,d kidney stone formatione,f,g Chloridea Blood pressure statush Cholinea Hypotension, fishy body odorc,i Coppera Liver damagec Fluoride Enamel and skeletal fluorosis Folatea,j Precipitating or exacerbating neuropathy in individuals deficient in B12c Iodinea Elevated TSH concentrationc Iron Gastrointestinal side effects Magnesiuma,k Diarrhea and other gastrointestinal issuesf Manganese Elevated blood concentrations and neurotoxicityc Molybdenuma Reproductive effectsb,c Niacina Flushingf Nickela,l Decreased body weight gainb,f Phosphorusa Hyperphosphatemiam,n,o,p Selenium Hair and nail brittleness and loss Sodiuma Blood pressure statusq Vanadiumr Renal toxicityb Vitamin A Teratogenicity,s liver abnormalities,t hypervitaminosis Ac,u Vitamin B6a,v Sensory neuropathyc Vitamin Ca Osmotic diarrhea and related gastrointestinal disturbancesc Vitamin D Hypercalcemia and related toxicityw Vitamin Ea Hemorrhagic effectsb,c Zinc Adverse effect on copper metabolism (i.e., reduced copper status) x NOTES: Tolerable upper intakes levels are established based on intake of food, water, and supplements, unless otherwise noted.
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From page 249...
... was derived by dividing the approximate upper boundaries of normal serum inorganic phosphate levels in adults by a larger uncertainty factor than used for the adult UL, to account for increased prevalence of impaired renal function. q UL for children (ages 1 to 18 years)
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From page 250...
... AI = Adequate Intake; DRI = Dietary Reference Intake; EAR = Estimated Average Requirement; RDA = Recommended Dietary Allowance. a Measures varied by DRI life stage group and incorporated data on calcium balance, which is not directly linked to a specific chronic disease end point.
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From page 251...
... 2016. History of nutri tion: The long road leading to the Dietary Reference Intakes for the United States and Canada.
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Key Terms

  • dietary reference
  • reference intakes
  • intake values
  • intake level
  • recommended dietary

  • reference intake
  • blood pressure
  • tolerable upper
  • nutritional adequacy
  • dietary allowances

  • dietary guidelines
  • disease risk
  • normal serum
  • inorganic phosphate
  • serum inorganic

  • phosphate levels
  • adverse effect
  • critical adverse
  • surrogate markers
  • using dietary

  • upper intake
  • integrate chronic
  • reducing chronic
  • larger uncertainty
  • nutrient adequacy

  • heart disease
  • dri values
  • bone health
  • coronary heart
  • nutrient intakes


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