Iron reference intake values for 7- to 23-month-old Brazilian children.

Large discrepancies exist among the dietary zinc recommendations set by expert groups. To describe the basis for the differences in the dietary zinc recommendations set by the World Health Organization, the US Institute of Medicine, the International Zinc Nutrition Consultative Group, and the European Food Safety Agency. We compared the sources of the data, the concepts, and methods used by the 4 expert groups to set the physiological requirements for absorbed zinc, the dietary zinc requirements (termed estimated and/or average requirements), recommended dietary allowances (or recommended nutrient intakes or population reference intakes), and tolerable upper intake levels for selected age, sex, and life-stage groups. All 4 expert groups used the factorial approach to estimate the physiological requirements for zinc. These are based on the estimates of absorbed zinc required to offset all obligatory zinc losses plus any additional requirements for absorbed zinc for growth, pregnancy, or lactation. However, discrepancies exist in the reference body weights used, studies selected, approaches to estimate endogenous fecal zinc (EFZ) losses, the adjustments applied to derive dietary zinc requirements that take into account zinc bioavailability in the habitual diets, number of dietary zinc recommendations set, and the nomenclature used to describe them. Estimates for the physiological and dietary requirements varied across the 4 expert groups. The European Food Safety Agency was the only expert group that set dietary zinc recommendations at 4 different levels of dietary phytate for adults (but not for children) and as of yet no tolerable upper intake level for any life-stage group.

Nutrient reference values (NRVs) for zinc set by several expert groups differ widely and may affect the predicted prevalence of inadequate zinc intake. We examined this possibility using NRVs published by four different authorities and nationally representative dietary intake data collected among children aged 12–59 months and women in Cameroon. Usual zinc intake was estimated from 24 h recall data using the National Cancer Institute method. Prevalences of total zinc intake below the dietary requirement and of “absorbable zinc intake” below the physiological requirement were estimated using NRVs published by the World Health Organization (WHO), US Institute of Medicine (IOM), International Zinc Nutrition Consultative Group (IZiNCG), and European Food Safety Authority (EFSA). The prevalence of inadequate zinc intake ranged from 10% (IZiNCG—physiological requirement, 95% CI 7–13%) to 81% (EFSA—physiological requirement, 95% CI 78–84%) among children and 9% (WHO—physiological requirement, 95% CI 8–11.0%) to 94% (IOM—physiological requirement, 95% CI 92–95%) among women These differences in the prevalence of inadequate intake translated into sizeable differences in the predicted benefit and cost-effectiveness of zinc fortification programs. Depending on the NRVs applied, assessments differ regarding the need for and design of zinc fortification programs. Efforts are needed to harmonize NRVs for zinc.

Excess sodium intake is a risk factor for non-communicable diseases (NCDs), such as cardiovascular diseases and hypertension. Therefore, many countries have set nutrient reference values for sodium, specifically for the prevention of NCDs, and intake is routinely monitored by nutrition surveys. In this review, we aimed to compare the global nutrient reference values and national intakes of sodium, along with the methods of intake assessment used. Data were obtained for Australia, Canada, Ireland, Japan, the UK, the US, and the European Food Safety Authority (EFSA), where information was accessible online in English or Japanese. We collected the following information regarding sodium intake: the term used for reference values to prevent NCDs; year when reference values were established or revised; reference values to prevent NCDs; target NCDs; designation of nutrition survey; method for estimating intake; and average intake. The reference values ranged from 2,000 mg (Australia and EFSA) to 2,953 mg (Japan). Sodium intake ranged from 2,431 mg (Australia) to 3,958 mg (Japan). Out of seven countries/institutions, five used dietary assessment, and two used sodium urinary excretion for estimating dietary sodium intake. Among the dietary assessment methods, the 24-h dietary recall was most frequently used. National sodium intake exceeded the reference values in all countries, and reduction of sodium intake remains a global challenge.

Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) derives dietary reference values (DRVs) for riboflavin. The Panel considers that the inflection point in the urinary riboflavin excretion curve in relation to riboflavin intake reflects body saturation and can be used as a biomarker of adequate riboflavin status. The Panel also considers that erythrocyte glutathione reductase activation coefficient is a useful biomarker, but has limitations. For adults, the Panel considers that average requirements (ARs) and population reference intakes (PRIs) can be determined from the weighted mean of riboflavin intake associated with the inflection point in the urinary riboflavin excretion curve reported in four intervention studies. PRIs are derived for adults and children assuming a coefficient of variation of 10%, in the absence of information on the variability in the requirement and to account for the potential effect of physical activity and the methylenetetrahydrofolate reductase 677TT genotype. For adults, the AR and PRI are set at 1.3 and 1.6 mg/day. For infants aged 7–11 months, an adequate intake of 0.4 mg/day is set by upward extrapolation from the riboflavin intake of exclusively breastfed infants aged 0–6 months. For children, ARs are derived by downward extrapolation from the adult AR, applying allometric scaling and growth factors and considering differences in reference body weight. For children of both sexes aged 1–17 years, ARs range between 0.5 and 1.4 mg/day, and PRIs between 0.6 and 1.6 mg/day. For pregnant or lactating women, additional requirements are considered, to account for fetal uptake and riboflavin accretion in the placenta during pregnancy or the losses through breast milk, and PRIs of 1.9 and 2.0 mg/day, respectively, are derived.

A review of the quality of evidence of nutrient reference values.

Iron deficiency is the most common nutritional deficiency globally. Premenopausal women are at particular risk due to increased requirements for iron associated with menstrual blood loss and pregnancy. To prevent iron deficiency, recommended intakes have been developed based on physiological requirements for absorbed iron and iron bioavailability. However, iron bioavailability is difficult to estimate as it depends on the composition of the diet and an individual’s absorptive efficiency. Several algorithms have been proposed to estimate iron bioavailability from diets based on the form of the iron and the presence of absorption modifiers. These algorithms can be complex and often underestimate bioavailability. Recently, a new approach was developed by Dainty et al.(1,2), which is based on calculated iron requirements, total dietary iron intakes, and the distribution of serum ferritin concentration values in the population. This model has been used by the European Food Safety Authority to set recommended iron intakes for adults(3). In contrast, the recommended iron intakes for Australian adults are based on iron bioavailability estimates from the US Institute of Medicine, which were primarily derived from 15 free living US adults(4). Therefore, the aim of this study was to predict dietary iron absorption in a representative sample of premenopausal Australian women using the model developed by Dainty et al.(1,2) Dietary iron intake and serum ferritin data from the 2011–13 Australian National Nutrition and Physical Activity Survey and National Health Measures Survey were analysed in 503 premenopausal women aged 18–49 years. Women were excluded if they were pregnant or lactating, had elevated C-reactive protein, consumed iron-containing supplements, or misreported energy intake. Dietary iron intake was assessed via two non-consecutive 24-hour recalls. Usual daily iron intake was determined by the Multiple Source Method. Dietary iron absorption was estimated using the predictive model developed by Dainty et al.(1,2) and the Institute of Medicine’s distribution of individual dietary iron requirements(4). Mean (SD) usual dietary iron intake was 10.4 (2.6) mg/d. The prevalence of serum ferritin < 15 μg/L was 14.1% (95% CI: 10.2%, 19.3%), and < 30 μg/L was 37.0% (95% CI: 31.8%, 42.5%). Predicted dietary iron absorption at serum ferritin concentrations of < 15 μg/L was 29.5%, and at serum ferritin concentrations of < 30 μg/L it was 19%. Our findings do not support the bioavailability assumption of 18% used to develop the Australian recommended iron intakes for premenopausal women based on the need to maintain serum ferritin concentrations of 15 μg/L. Our results may be useful in revising the recommended iron intakes for Australian premenopausal women.

The European Commission requested the European Food Safety Authority (EFSA) to update the dietary reference values (DRVs) for the European Union (EU) previously set by the Scientific Committee on Food (1993). DRVs are science-based reference values for nutrient intake of healthy people. The work on energy, water, macronutrients and vitamins has been completed (2017); that on minerals has continued (2019). We present the derivation of DRVs for 14 vitamins for adults.To set DRVs for adults, EFSA either used biomarkers of status, a factorial approach, data on health outcomes, or updated EU intake estimates. The latter were initially taken from publications. EFSA then compiled its own food composition database and calculated intake estimates combining it with individual data from representative national surveys from the EFSA Comprehensive European Food Consumption Database.EFSA set adequate intakes (AIs) for 7 vitamins, and population reference intakes (PRIs) for 7 others, for adults. Based on its review of biomarkers, health outcomes and intake, EFSA confirmed previous DRVs for vitamin K (per kg of body weight), niacin and thiamin (per MJ). Distinct updated values for women and men were derived for vitamins A, B6, C and E. DRVs for vitamins B6 and E were changed to daily amounts (instead of per g of protein or PUFA intake, respectively). Vitamin E was defined as alpha-tocopherol only (instead of alpha-tocopherol equivalents), and the DRV for folate was expressed in μg of dietary folate equivalents (instead of μg). DRV for cobalamin became an AI with an increased value compared to the previous PRI. Using updated intake estimates for biotin and pantothenic acid, and intake-status relationship for vitamin D, EFSA set AIs instead of previous acceptable ranges of intake. EFSA increased the PRI for folate, and that for riboflavin for women, considering data on biomarkers, and also those for vitamins A and C following a factorial approach. For the first time, a DRV for choline for the EU population was set, based on observed intakes and data on correction of deficiency symptoms.This review of available evidence led to a substantial update of the previous DRVs for vitamins. It also showed the need for more studies specifically designed to assess nutritional requirements, or to measure food composition (e.g. vitamin K, choline). There is also a need for the development and improvement of biomarkers of intake or status and relevant analytical methods for their use in setting DRVs.

Relevance of dietary iron intake and bioavailability in the management of HFE hemochromatosis: a systematic review

EFSA Supporting PublicationsVolume 12, Issue 10 876E Technical reportOpen Access Outcome of a public consultation on the Draft Scientific Opinion of the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) on Dietary Reference Values for iron European Food Safety Authority (EFSA), European Food Safety Authority (EFSA)Search for more papers by this author European Food Safety Authority (EFSA), European Food Safety Authority (EFSA)Search for more papers by this author First published: 21 October 2015 https://doi.org/10.2903/sp.efsa.2015.EN-876 Published date: 21 October 2015 Question number: EFSA-Q-2015-00260 AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References Bannon DI, Abounader R, Lees PS and Bressler JP, 2003. Effect of DMT1 knockdown on iron, cadmium, and lead uptake in Caco-2 cells. American Journal of Physiology. Cell Physiology, 284, C44– 50. D-A-CH (Deutsche Gesellschaft für Ernährung – Österreichische Gesellschaft für Ernährung – Schweizerische Gesellschaft für Ernährungsforschung – Schweizerische Vereinigung für Ernährung), 2013. Referenzwerte für die Nährstoffzufuhr. Umschau Braus Verlag, Frankfurt/Main, Germany, 292 pp. Dainty JR, Berry R, Lynch SR, Harvey LJ and Fairweather-Tait SJ, 2014. Estimation of dietary iron bioavailability from food iron intake and iron status. PLoS ONE, 9, e111824. EFSA (European Food Safety Authority), 2004. Scientific opinion of the Panel on Dietetic Products, Nutrition and Allergies (NDA Panel) on a request from the Commission related to the Tolerable Upper Intake Level of iron. The EFSA Journal 2004, 125, 1– 34. EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2010. Scientific Opinion on principles for deriving and applying Dietary Reference Values. EFSA Journal 2010; 8(3):1458, 30 pp. doi:10.2903/j.efsa.2010.1458 EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2013. Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA Journal 2013; 11(10):3408, 103 pp. doi:10.2903/j.efsa.2013.3408 EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2015. Scientific Opinion on Dietary Reference Values for iron. EFSA Journal 2015; 13(10):4254, 115 pp. doi:10.2903/j.efsa.2015.4254 Fomon SJ, Nelson SE, Serfass RE and Ziegler EE, 2005. Absorption and loss of iron in toddlers are highly correlated. Journal of Nutrition, 135, 771– 777. Gallagher CM, Chen JJ and Kovach JS, 2011. 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Cadmium in blood and urine – impact of sex, age, dietary intake, iron status, and former smoking – association of renal effects. Environmental Health Perspectives, 110, 1185– 1190. SACN (Scientific Advisory Committee on Nutrition), 2010. Iron and health. The Stationery Office, London, UK, 373 pp. Shah F, Kazi TG, Afridi HI, Kazi N, Baig JA, Shah AQ, Khan S, Kolachi NF and Wadhwa SK, 2011. Evaluation of status of trace and toxic metals in biological samples (scalp hair, blood, and urine) of normal and anemic children of two age groups. Biological Trace Element Research, 141, 131– 149. Vahter M, Akesson A, Liden C, Ceccatelli S and Berglund M, 2007. Gender differences in the disposition and toxicity of metals. Environmental Research, 104, 85– 95. Wennberg M, Lundh T, Bergdahl IA, Hallmans G, Jansson JH, Stegmayr B, Custodio HM and Skerfving S, 2006. Time trends in burdens of cadmium, lead, and mercury in the population of northern Sweden. Environmental Research, 100, 330– 338. 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Following a request from the European Commission, the EFSA Panelon Dietetic Products, Nutrition and Allergies (NDA) derives Dietary Reference Values (DRVs) for vitaminB6. The Panelconsiders that plasma pyridoxal 5'-phosphate (PLP) concentration is the biomarker of status suitable for deriving DRVs for vitaminB6. Considering that a plasma PLP concentration of 30nmol/L, as a population mean, is indicative of an adequate vitaminB6 status, the Panelproposes to use this cut-off value to set Average Requirements (ARs). Population Reference Intakes (PRIs) are derived for adults and children from ARs, assuming a coefficient of variation (CV) of 10%. For women, the AR and PRI are set at 1.3 and 1.6mg/day. For men, the AR of 1.5mg/day is derived by an allometric scaling from the AR for women, and a PRI of 1.7mg/day is set. For all infants aged 7-11months, an Adequate Intake of 0.3mg/day is set, averaging the results of two extrapolation approaches based on an allometric scaling: upwards extrapolation from the estimated vitaminB6 intake of exclusively breastfed infants from birth to 6months, and downwards extrapolation from the ARs for adults applying a growth factor. For all children, ARs are derived from adult ARs using an allometric scaling and growth factors. For children of both sexes aged 1-14years, ARs range between 0.5 and 1.2mg/day. For children aged 15-17years, the Panelderives the same ARs as for adults. PRIs for children aged 1-17years range between 0.6and 1.7mg/day. Extrapolation of ARs by an allometric scaling considered differences in reference body weight. For pregnant and lactating women, additional requirements are considered, based on the uptake of vitaminB6 by the fetal and maternal tissues and the losses through breast milk, and PRIs of 1.8 and 1.7mg/day, respectively, are derived.

Why the Derivation of Nutrient Reference Values Should be Harmonized and How It Can be Accomplished

Protein intake pattern in non-breastfed infants and toddlers: A survey in a nationally representative sample of French children

Modeled healthy eating patterns are largely constrained by currently estimated requirements for bioavailable iron and zinc—a diet optimization study in French adults

Obesity increases the risk for iron deficiency, but the underlying mechanism is unclear. It is possible that overweight individuals may have lower dietary iron intake and/or bioavailability. Alternatively, obesity-related inflammation may increase hepcidin concentrations and reduce iron availability. Circulating hepcidin levels have not been compared in normal weight vs overweight individuals. The objective of this study was to compare iron status, dietary iron intake and bioavailability, as well as circulating levels of hepcidin, leptin and interleukin-6 (IL-6), in overweight vs normal weight children. In 6-14-year-old normal and overweight children (n=121), we measured dietary iron intake, estimated iron bioavailability and determined body mass index s.d. scores (BMI-SDS). In all children (n=121), we measured fasting serum ferritin, soluble transferrin receptor (sTfR), C-reactive protein (CRP) and leptin; in a subsample, we measured IL-6 (n=68) and serum hepcidin (n=30). There were no significant differences in dietary iron intake or bioavailability comparing normal and overweight children. The prevalence of iron-deficient erythropoiesis (an increased sTfR concentration) was significantly higher in the overweight than in the normal weight children (20 vs 6%, P=0.022, with sTfR concentrations of 4.40+/-0.77 and 3.94+/-0.88 mg l(-1), respectively, P=0.010). Serum hepcidin levels were significantly higher in the overweight children (P=0.001). BMI-SDS significantly correlated with sTfR (P=0.009), serum hepcidin (P=0.005) and the three measures of subclinical inflammation, namely CRP (P<0.001), IL-6 (P<0.001) and leptin (P<0.001). In a multiple regression model, serum hepcidin was correlated with BMI-SDS (P=0.020) and body iron (P=0.029), but not with the inflammatory markers. Our findings indicate that there is reduced iron availability for erythropoiesis in overweight children and that this is unlikely due to low dietary iron supply but rather due to hepcidin-mediated reduced iron absorption and/or increased iron sequestration.

Calcium and vitamin D and bone strength ‐ Scientific substantiation of a health claim related to calcium and vitamin D and bone strength pursuant to Article 14 of Regulation (EC) No 1924/2006 ‐ Scientific Opinion of the Panel on Dietetic Products, Nutrition and Allergies