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Review of Dietary Reference Intakes for Selected Nutrients

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Review of Dietary Reference Intakes for Selected Nutrients Review of Dietary Reference Intakes for Selected Nutrients Challenges and Implications for Federal Food and Nutrition Policy Contractor and Cooperator Report No. 28 February 2007 By Barbara Devaney, Mary Kay Crepinsek, Ken Fortson, and Lisa Quay, Mathematica Policy Research, Inc. Abstract Dietary Reference Intakes (DRIs) are the most recent set of nutrient-based reference values, which, together with recommended dietary assessment methods, are being used to update estimates of nutrient adequacy of population subgroups. Recent estimates suggest both dramatic dietary deficiencies and excesses for selected nutrients among some subgroups. This report takes a critical look at the studies and methods used to set DRIs. The findings show that errors in dietary recall data—either underreporting or overreporting of intakes—may partially explain the inadequacies and excessive intakes. In addition, the lack of sensitive, specific biochemical markers has resulted in DRIs for selected nutrients to be based on less than optimal data. Because the DRIs are used by food and nutrition assistance programs to set nutritional objectives, establish program benefits, and evaluate program outcomes, it is important to understand the issues involved in deriving the DRIs and how to interpret the results of dietary assessments. This study was conducted by Mathematica Policy Research, Inc., under a cooperative research contract with USDA’s Economic Research Service (ERS) Food and Nutrition Assistance Research Program (FANRP): contract number 43-3K06-06-3114 (ERS project representative: Elizabeth Frazao). The views expressed are those of the authors and not necessarily those of ERS or USDA. 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 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 (UL) for Preformed Vitamin A for Infants and Young Children .............................................................................. 34 IV.5 Studies Assessing the Magnesium Intake of Older Children and Adults.......... 39 IV.6 Derivation of the Estimated Average Requirement (EAR) for Magnesium for Children and Adults ............................................................................................ 42 IV.7 Studies Assessing the Vitamin E Intake of Children and Adults ....................... 49 IV.8 Derivation of the Estimated Average Requirement (EAR) for Vitamin E for Children and Adults ............................................................................................ 53 IV.9 Studies Assessing the Dietary Fiber Intake of Children and Adults .................. 58 IV.10 Derivation of the Average Intake (AI) for Total Fiber........................................ 60 IV.11 Studies Assessing the Potassium Intake of Children and Adults........................ 65 IV.12 Derivation of the Average Intake (AI) for Potassium.......................................... 67 V.1 Re-Examination of the DRIs for Selected
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