Dietary Reference Intakes (DRIs) PDF

Module 2: Dietary Reference Intakes Part 1: History of Dietary Standards and Overview of the DRIs Part 2: A Closer Look at DRIs, Body Mass Index 1 Brief History of Dietary Recommendations First dietary recommendations published in 1894 by USDA and mai...

Module 2: Dietary Reference Intakes Part 1: History of Dietary Standards and Overview of the DRIs Part 2: A Closer Look at DRIs, Body Mass Index 1 Brief History of Dietary Recommendations First dietary recommendations published in 1894 by USDA and mainly described adequate amounts of proteins, carbohydrates, fat and mineral water. 1917 – How to Select Foods was published, introducing 5 food groups Bread and cereals Fats and oils Sweets Meats and meat substitutes (poultry, eggs, legumes, etc.) The importance of vitamins was not yet known at the time. This concept of “food groups” is still in use today. 3 https://archive.org/details/howtoselectfoods00hunt History cont. In 1940s RDAs (recommended daily allowances) were established based on the amounts that would prevent deficiencies Malnourishment and disease were the main drivers, with the goal of having a healthy wartime fighting force The original RDAs made recommendations on energy (calories) and nine essential nutrients—protein, iron, calcium, vitamins A and D, thiamin, riboflavin, niacin, and ascorbic acid that caused common diseases 4 Contemporary Dietary Guidelines for Americans Dietary guidelines are established by the U.S. Department of Agriculture (USDA) jointly with the Department of Health and Human Services (DHHS) and are revised every 5 years The first guidelines were published in 1980 to promote health, reduce obesity and chronic diseases The Center for Nutrition Policy and Promotion (CNPP) is an agency in The U.S. Department of Agriculture that was created in 1994 to provide nutritional guidance. My pyramid replaced the food guide pyramid in 2005 to include a figure intended to emphasize the importance of exercise 5 Current Guidelines: MyPlate Myplate is the current nutrition guide published by the CNPP (under USDA) and it replaced Mypyramid in 2011 The guide still contains the same categories as Mypyramid but with a reduction in the amount of grains, and an increase in vegetables and fruit which now take up half the plate combined The new visual is intended to be easier to interpret by the public 6 Dietary Reference Intakes (DRIs) DRIs are a set of nutrient reference standards that are used for planning and assessing diets of apparently healthy individuals and groups the number of calories percentage of macronutrients amounts of micronutrients DRIs values provide scientific basis for nutrition professionals, healthcare providers, and organizations DRIs are also used to develop the “% Daily Value” on nutrition labels. 7 DRIs are Based on Metrics Health metrics are averaged for a given group by age and sex: Growth rate of male infants 0-6 months Obesity rate for children ages 9-13 Iron deficiency in men ages 51-70 Weight, height, and blood or urine analysis are indicators of appropriate ranges for nutrients. For example, a cholesterol test can indicate if a diet is too high in fats 8 DRIs are used for Macro- and Micro- Nutrients Macronutrients: nutrients required in relatively large amounts Provide energy and building blocks for growth and repair The macronutrients are carbohydrates, fats and proteins Micronutrients: nutrients required in smaller amounts Cofactors in enzymatic reactions (e.g., thiamine, niacin, riboflavin) Antioxidants (e.g., vits A, C, E) Minerals (e.g., calcium, iron, potassium) 9 The Six DRIs DRIs for energy and macronutrients Estimated Energy Requirement (EER) Acceptable Macronutrient Distribution Ranges (AMDR) DRIs for most other nutrients Estimated Average Requirement (EAR) Recommended Dietary Allowance (RDA) Adequate Intake (AI) Tolerable Upper Intake Level (UL) 10  Summary Table of the Six DRIs Energy and A range of usual intakes for a macronutrient that is associated with reduced Macronutrients Acceptable Macronutrient Distribution risk of chronic disease while providing adequate intakes of essential nutrients. Range (AMDR) An AMDR is expressed as a percentage of total energy intake. A calculated level of energy intake that is estimated to maintain energy balance (or as appropriate, normal growth), that incorporates weight, height, Estimated Energy Requirement (EER) physiological state (i.e., pregnancy), and level of energy expenditure. Measured for a specific individual. Most Nutrients The usual daily intake of a nutrient that is expected to meet the requirement Estimated Average Requirement (EAR) of half of healthy individuals in a group defined by age and sex. The usual daily intake level that is sufficient to meet the nutrient requirements Recommended Dietary Allowance (RDA) of 97 to 98% of healthy individuals in the specified sex and life-stage group. When available evidence is not sufficient to determine the EAR for a nutrient, an AI is set. The AI is the average daily nutrient intake observed in an Adequate Intake (AI) apparently healthy sex and age group. It is based on experimentally derived intake levels or observations of mean nutrient intakes by a group of apparently healthy people. The highest usual daily nutrient intake level that is likely to pose no risk of Tolerable Upper Intake Level (UL) adverse effects to nearly all healthy individuals in the specified sex and life- stage group. 11 Module 2 Part 2: A Closer Look at DRIs, Body Mass Index 12  DRIs for Energy Estimated Energy Requirement (EER) The average dietary energy intake (kcal) to maintain weight in healthy individuals Based on age, sex, weight, height, level of physical activity to maintain energy balance. It is an average for the subset of a population you belong to, you might need less or more The EER does not refer to a specific nutrient. It refers to calories combined from all nutrients in one day EER calculators can be used to determine an individual’s energy needs: https://globalrph.com/medcalcs/estimated-energy- requirement-eer-equation/ 13  DRIs for Energy EER- Kilocalorie (kcal) levels table What is a “kcal”? Energy from food is measured in Calories (capital ‘C’) but this is a large number! For convenience, food energy is reported using kcal. We just call them calories for simplicity. 1 kcal = 1000 calories A small apple has 78 kcal or 78,000 Calories. We just say 78 calories. 14  DRIs for Energy Acceptable Macronutrient Distribution Range- AMDR The AMDR describes the portion of energy intake that should come from each macronutrient Keep in mind that the percentage of daily caloric intake from the three energy-yielding macronutrients will add up to 100 percent, so the These are general ranges for all proportion of each influences the healthy people. However, an other two individual’s specific needs may The AMDR is based upon an differ based upon factors such as individual’s EER lifestyle, age, sex, and genetics. For example, elderly people need less fat but more protein than someone in middle-age. 15  DRIs for Energy Calculating Energy Value of Food Energy comes from the 3 macronutrients Fat: 9 kilocalories/gram Carbohydrates: 4 kilocalories/gram Proteins: 4 kilocalories/gram To calculate the energy value of food: Multiply weight of each macronutrient in grams by energy value from above Add kilocalories for the 3 macronutrients together 16  DRIs for Energy Calculating Energy from Food: Example This chicken sandwich contains 39 grams of fat, 66 grams of carbs and 48 grams of protein. Since each gram of fat contains 9 calories, each gram of carbs contain 4 calories and each gram of protein 4 calories: You get: 39x9= 351 66x4= 264 48x4= 192 351+264+192= 807 calories for one sandwich For a person with an EER of 1800 kcal/day this one sandwich makes up almost half of their daily energy needs! 17  DRIs for Energy Using EER to estimate AMDR 1. Use an EER calculator to estimate your energy needs (daily calorie intake) 2. Calculate the range of calories that should come from each of the macronutrient categories 3. Divide the values you obtain by the calories per gram for that macronutrient For example, to determine your AMDR for protein: 10-35% of kilocalories should come from protein If your EER is 1800kcal calories/day, that range is: Low end: 0.10*1800kcal= 180kcal/4g High end: 0.35*1800kcal=630kcal/4g Each day you should consume between 45-157.5 grams of protein. Practice this on your own in the homework activity! 18  DRIs for Nutrients Estimated Average Requirement (EAR) The EAR is the estimated average daily intake level of a nutrient that will meet the needs of 50% the healthy individuals in a particular life stage The EAR is used to establish other DRIs or for population metrics. For example, the EAR of Half of the population’s needs fall folate for adults is above the EAR value (light purple approximately 250 ug/day, on the graph). This means that meaning 50% of healthy they do not have their needs met adults consume that much at the EAR intake level folate daily. 19  DRIs for Nutrients Recommended Daily Allowance (RDA) The RDA is the average daily intake level sufficient to meet the needs of nearly all people: 97-98% RDA is calculated based on the EAR value and safety The RDA is the goal for usual intake by an individual The RDA is used for Daily Value percentages on nutrition labels For example, the RDA for folate for adult men and women is 400 ug/day This is the amount needed by most adults, excluding pregnant women who need more. 20  DRIs for Nutrients Adequate Intake (AI) AI is the recommended average daily intake level for nutrients that do not have RDA When there is not enough information to establish an RDA for a particular nutrient for a specific population AI is used instead Based on observations, estimates from experiments, and clinical data 21  DRIs for Nutrients Tolerable Upper Intake Level (UL) UL is the highest average daily intake that is safe for most people Consumption of a nutrient at levels above the UL is not considered safe 22 Relationship Between DRIs 23 Body Mass Index NOTE: BMI is not a DRI Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women. Uses weight and height to assess whether the weight of a female or male is within a healthy range. 24  Problems with BMI BMI has recently come under criticism for being an inaccurate assessment of healthy weight. BMI is based on averages of non-Hispanic Whites. Some other populations Are these athletes might have different obese? ranges for healthy weights. Based upon weight and height so people with a lot of muscle and little fat can be classified as obese by using only BMI 25