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Review of the Dietary Reference Intakes for Selected Nutrients: Application Challenges and Implications for Food and Nutrition Assistance Programs

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Review of the Dietary Reference Intakes for Selected Nutrients: Application Challenges and Implications for Food and Nutrition Assistance Programs Contract No.: 43-3K06-06-3114 MPR Reference No.: 6234-500 Review of the Dietary Reference Intakes for Selected Nutrients: Application Challenges and Implications for Food and Nutrition Assistance Programs November 2006 Barbara Devaney Mary Kay Crepinsek Ken Fortson Lisa Quay Submitted to: Submitted by: U.S. Department of Agriculture Mathematica Policy Research, Inc. Economic Research Service, FRED P.O. Box 2393 1800 M Street, NW, Room N4101 Princeton, NJ 08543-2393 Washington, DC 20036-5831 Telephone: (609) 799-3535 Facsimile: (609) 799-0005 Project Officer: Project Director: Elizabeth Frazao Barbara Devaney A BSTRACT utrient reference standards are used by food and nutrition assistance programs to set nutritional objectives, establish program benefits, and evaluate program Noutcomes and effectiveness. One of the most prominent applications of these standards is in the Thrifty Food Plan, a food plan designed to meet nutrient standards at a minimal cost and used to set benefits for the Food Stamp Program. Similarly, nutrient reference standards are used in determining the specific nutrition goals that must be met by meals and snacks offered by child nutrition programs. Findings from dietary assessment studies using nutrient reference standards were also an important component of the recent Institute of Medicine review of the food package for the Special Supplemental Nutrition Program for Women, Infants, and Children. Over the last decade, increased knowledge about nutrient requirements and advances in dietary assessment methods have resulted in updated estimates of the nutrient adequacy of key population subgroups. Some surprising findings have emerged from this “first- generation” set of results that have followed the development of both the DRIs and methods for their use in assessing dietary adequacy. The findings are surprising in the sense that they suggest dramatic dietary deficiencies as well as excesses among some population subgroups, although they do not appear to be accompanied by adverse health conditions. Given the integral role of dietary reference standards and dietary assessments to food and nutrition assistance programs and policies, it is critical to examine carefully these recent findings to determine the extent to which they may result from shortcomings in the dietary reference standards and dietary assessment methods, or may be indicative of true dietary problems. This report takes a critical look at the methods used to set the DRIs for energy and six nutrients – zinc, vitamin A, magnesium, vitamin E, fiber, and potassium – in an effort to better understand the findings of dietary assessment studies and to determine whether they signal important public health concerns that need to be incorporated into the design of food and nutrition assistance programs. Contents Chapter Page I INTRODUCTION.......................................................................................................... 1 BACKGROUND............................................................................................................. 1 OVERVIEW OF REPORT ........................................................................................... 3 II NUTRIENT REQUIREMENTS AND DIETARY ASSESSMENT METHODS.......................................................................................................................5 NUTRIENT REQUIREMENTS.................................................................................. 5 ENERGY REQUIREMENTS ...................................................................................... 8 DIETARY ASSESSMENT METHODS ..................................................................... 8 What Proportion of a Population Subgroup has Nutrient Intakes that Do Not Meet Nutrient Requirements? ......................................................... 9 What Proportion of a Population Subgroup is at Risk of Excessive Intake Levels?..................................................................................................10 SUMMARY .....................................................................................................................10 III ESTIMATED ENERGY REQUIREMENTS FOR INFANTS AND YOUNG CHILDREN..................................................................................................11 BACKGROUND...........................................................................................................12 REVIEW OF STUDIES ASSESSING USUAL ENERGY INTAKES ..............13 RE-ESTIMATION OF THE TOTAL ENERGY EXPENDITURE EQUATIONS.................................................................................................................16 Methods ....................................................................................................................17 Results .......................................................................................................................18 DISCUSSION.................................................................................................................21 vi IV REVIEW OF STUDIES USED TO SET THE DIETARY REFERENCE INTAKES FOR SELECTED NUTRIENTS ...........................................................23 ZINC ................................................................................................................................24 Studies Assessing Usual Zinc Intakes...................................................................24 Method and Data Used to Derive the UL for Zinc ...........................................26 Discussion.................................................................................................................28 VITAMIN A....................................................................................................................31 Studies Assessing Usual Preformed Vitamin A Intake ......................................32 Methods and Data Used to Derive the UL for Vitamin A................................34 Discussion.................................................................................................................35 MAGNESIUM................................................................................................................37 Studies Assessing Usual Magnesium Intake ........................................................38 Method and Data Used to Derive the EAR for Magnesium ............................38 Discussion.................................................................................................................45 VITAMIN E....................................................................................................................47 Studies Assessing Usual Vitamin E Intake ..........................................................48 Methods and Data Used to Derive the EAR for Vitamin E.............................51 Discussion.................................................................................................................54 FIBER...............................................................................................................................57 Studies Assessing Usual Intake of Dietary Fiber ................................................57 Method and Data Used to Derive the AI for Fiber ...........................................58 Discussion.................................................................................................................62 POTASSIUM ..................................................................................................................63 Studies Assessing Usual Potassium Intake...........................................................64 Method and Data Used to Derive the AI for Potassium...................................64 Discussion.................................................................................................................69 V CONCLUSIONS............................................................................................................71 STUDY FINDINGS AND RESEARCH NEEDS..................................................72 CONCLUDING DISCUSSION.................................................................................77 REFERENCES...............................................................................................................79 Contents Tables Table Page II.1 Dietary Reference Intakes........................................................................................... 6 III.1 Estimated Energy Requirement (EER) for Boys and Girls ................................ 13 III.2 Studies Assessing Usual Energy Intake of Infants and Young Children........... 15 III.3 Total Energy Expenditures and Estimated Energy Requirements—Fixed Effects Models ........................................................................................................... 19 III.4 Total Energy Expenditures and Estimated Energy Requirements—OLS Models .........................................................................................................................20 IV.1 Studies Assessing the Zinc Intake of Infants and Young Children.................... 25 IV.2 Derivation of the Tolerable Upper Limit (UL) for Zinc for Infants and Young Children.......................................................................................................... 27 IV.3 Studies Assessing the Preformed Vitamin A Intake of Infants and Young Children.......................................................................................................................33 IV.4 Derivation of the Tolerable Upper Limit
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