Reference Values For Nutrient Intake Research Articles

Integration of various dimensions in food-based dietary guidelines via mathematical approaches: report of a DGE/FENS Workshop in Bonn, Germany, 23-24 September 2019.

In the past, food-based dietary guidelines (FBDGs) were derived nearly exclusively by using systematic reviews on diet-health relationships and translating dietary reference values for nutrient intake into foods. This approach neglects many other implications that dietary recommendations have on society, the economy and environment. In view of pressing challenges, such as climate change and the rising burden of diet-related diseases, the simultaneous integration of evidence-based findings from different dimensions into FBDGs is required. Consequently, mathematical methods and data processing are evolving as powerful tools in nutritional sciences. The possibilities and reasons for the derivation of FBDGs via mathematical approaches were the subject of a joint workshop hosted by the German Nutrition Society (DGE) and the Federation of European Nutrition Societies (FENS) in September 2019 in Bonn, Germany. European scientists were invited to discuss and exchange on the topics of mathematical optimisation for the development of FBDGs and different approaches to integrate various dimensions into FBDGs. We concluded that mathematical optimisation is a suitable tool to formulate FBDGs finding trade-offs between conflicting goals and taking several dimensions into account. We identified a lack of evidence for the extent to which constraints and weights for different dimensions are set and the challenge to compile diverse data that suit the demands of optimisation models. We also found that individualisation via mathematical optimisation is one perspective of FBDGs to increase consumer acceptance, but the application of mathematical optimisation for population-based and individual FBDGs requires more experience and evaluation for further improvements.

Update by the European Food Safety Authority of the dietary reference values for vitamins set for adults in the EU

AbstractThe 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.

Fluid intake in children

AbstractIntroductionWe monitored fluid intake in children. The hydration of children during morning school classes and on consumption of high-calorie drinks. Subclinical dehydration, expressed as urine osmolarity above 800 mmol / kg, may result in lack of concentration and less effective listening.Population and methodologyThe population included 3,360 children aged as follows: a) 6–35 months, b) 4–6 years, c) 7–10 years d) 11–14 years. 103 children aged 10.3 ± 1 years were included in the study regarding body hydration. The evaluation looked at the intake of food and fluids consumed by children in full-day diet over a period of 3 to 5 days and recorded by the Nutridan program. Child hydration was assessed using three urine osmolarity samples taken at bedtime, in the morning and just before lunch break. The data was evaluated statistically against the reference values for nutrient intake of DACH.Results and discussionThe median water intake in children was 101–103% of the Dietary Reference Values (DRV). In the b, c, d groups, the median was 81% - 82%, i.e 75% of DRV. 10% of 4 to 6-year-old children had water intake below 49% of DRV, 10% of 7 to 10 year-olds less than 54% of DRV and 10% of 11 to 14-year-olds less than 50% of DRV. A study regarding school children has showed that only 70% of the children drink at breakfast. 27% of the children do not consume any fluids in the morning. The mean urine osmolarity was 724 in the morning and 738 mmol / kg just before lunch. Children who had drunk less than 250 ml of water during breakfast or less than 400 ml of water during breakfast and second breakfast had a urine osmolarity of 910 and 850 mmol / kg respectively just before lunch. In school children, the proportion of sugars received from sweetened beverages accounted for 19.1% of their total calorie intake. 10% of the children in groups c) and d) had this value higher than 28.2 and 30.4% respectively. The results based on full-day diet show that sweetened drinks account for 79% of fluids consumed by children at school, whereas only for 72% at home.The results of our studies have identified the areas where it is necessary to provide education regarding nutrition of children, to raise awareness of the importance of fluid intake, particularly focusing on the systematic approach and the choice of appropriate beverages ensuring adequate fluid intake.

The Revised D-A-CH-Reference Values for the Intake of Vitamin B12 : Prevention of Deficiency and Beyond.

ScopeThe nutrition societies of Germany, Austria, and Switzerland are the joint editors of the “D‐A‐CH reference values for nutrient intake”, which are revised regularly.Methods and ResultsBy reviewing vitamin‐B12‐related biomarker studies, the reference values for vitamin B12 were revised in 2018. For adults, the estimated intake is based on the adequate serum concentrations of holotranscobalamin and methylmalonic acid. The estimated values for children and adolescents are extrapolated from the adult reference value by considering differences in body mass, an allometric exponent, and growth factors. For infants below 4 months of age, an estimated value is set based on the vitamin B12 intake via breast milk. The reference values for pregnant and lactating women consider the requirements for the fetus and for loss via breast milk. The estimated values for vitamin B12 intake for infants, children, and adolescents range from 0.5 to 4.0 µg d−1. For adults, the estimated values are set at 4.0 µg d−1, and for pregnant and lactating women, they are set at 4.5 and 5.5 µg d−1, respectively.ConclusionBased on the data of several vitamin B12 status biomarkers studies, the reference value for vitamin B12 intake for adults is raised from 3.0 to 4.0 µg d−1.

New Reference Values for Vitamin C Intake

The German, Austrian, and Swiss nutrition societies are the editors of the ‘reference values for nutrient intake'. They have revised the reference values for the intake of vitamin C and published them in February 2015. The average vitamin C requirement in healthy adults is considered to be the vitamin C amount that compensates for the metabolic losses of vitamin C, and ensures a fasting ascorbate plasma level of 50 µmol/l. Based on the present data from studies with non-smoking men, metabolic losses of 50 mg/day are assumed, as well as an absorption rate of 80% and an urinary excretion of 25% of the vitamin C intake. Taking this into account, the calculated average requirement in men is 91 mg/day. Considering a coefficient of variation of 10%, a reference value (recommended intake) of 110 mg/day for men is derived. The vitamin C requirement in women as well as in children and adolescents is extrapolated from the requirement in men and in relation to their body weight. This results in a recommended intake of about 95 mg/day for adult women. Because the requirement in pregnant and lactating women is increased, higher recommended intakes are derived for them, 105 mg/day for pregnant women from the fourth month on and 125 mg/day for lactating women, respectively. For boys and girls at the age of 1 to under 15 years, there are increasing recommended intake values from 20 to 85 mg/day. For male and female adolescents, at the age of 15 to under 19 years, the recommended intake is 105 and 90 mg, respectively. As smokers have higher metabolic losses and lower plasma levels of vitamin C than non-smokers (turnover is 40% higher), the reference value for vitamin C intake is set to 135 mg/day for female smokers and 155 mg/day for male smokers. For infants in their first year of life, the reference value (estimated value) is set to 20 mg vitamin C/ day, based upon the lowest observed vitamin C intake for infants in the United Kingdom and the United States, that obviously meets the requirement in infants and that is 3 times higher than the amount necessary to prevent scurvy (7 mg/day).

Vitamin and mineral nutritional status of healthy pregnant women improved by nutrient supplements

Including varied and healthy food in daily diet that contains adequate amounts of nutrients is vital during pregnancy, especially when there is an increased requirement for several micronutrients. The aim of this study was to evaluate vitamin and mineral status of healthy pregnant women (N = 69) and to determine whether nutrient supplements improve their nutritional status. The evaluation of nutritional status was done by Prodi 5.7 Expert Plus computer programme and IBM SPSS Statistics 20.0 for statistical analysis. Nutrient intake of vitamins C, D, E, folic acid and minerals iron, iodine, calcium and sodium were compared with Reference values for nutrient intake (2004). Results of our study show that the most problematic nutrients are folate, iron and vitamin D. Intake of vitamins and minerals with food is of concern, as 46.4 % of all participants are indicated as women with poor nutritional status (sufficient in two or less nutrients), moreover none of them met the demand for six out of seven studied nutrients. Taking supplementation into account, 27.5 % of participants covered the need for six or more nutrients, however almost a quarter of studied subjects still remain in the group with poor nutritional status. In conclusion among participants who decided to take supplements, the vast majority of them improved their vitamin-mineral status moreover few of them improved their status significantly. Therefore the use of nutrient supplements could on average improve vitamin-mineral status as intake with a diet is obviously inadequate.

New Reference Values for Calcium

The nutrition societies of Germany, Austria and Switzerland are the joint editors of the ‘reference values for nutrient intake'. They have revised the reference values for the intake of calcium and published them in June 2013. The reference values for the calcium intake for infants are derived from the calcium content of breast milk. For infants from 4 to <12 months of age, the calcium intake from solid foods is included in addition to the calcium intake from breast milk. Thus, the reference values for infants are estimated values; they are 220 mg/day for infants to <4 months and 330 mg/day for infants from 4 to <12 months of age. As a parameter for determining the calcium requirement in children and adolescents, calcium retention is taken into account. The average requirement is calculated by the factorial method. A balanced calcium metabolism is calculated based upon calcium balance studies and used as a parameter for the determination of the calcium requirement in adults. On the basis of the average requirement, recommended calcium intake levels for children, adolescents and adults are derived. Depending on age, the recommended calcium intake ranges between 600 mg/day for children aged 1 to <4 years and 1,200 mg/day for adolescents aged 13 to <19 years; for adults, it is 1,000 mg/day.

Regional survey of neurodisabled clients in the community on long-term tube feeding as a main source of nutrition

Background: It is well recognised that some people with cerebral palsy and other conditions have low energy requirements because they lack mobility and have a low resting energy expenditure (Dickerson et al., 1999). When tube fed, it may be necessary to give a reduced amount of an age appropriate feed to ensure an appropriate energy intake and avoid excessive weight gain, although this may compromise the intake of other nutrients (Skelton et al., 2006). The aim of the survey was to compare prescribed nutrient intake of tube fed clients, who have enteral feeding as their major source of nutrition, with dietary reference values. Methods: Data on type and quantity of prescribed feeds was collected retrospectively from the case notes of 59 adults and 16 children aged >3 years with a learning disability who have tube feeds as their main source of nutrition. A nutritional analysis of the feed was completed using Microdiet dietary analysis programme, which was compared with the reference values for nutrient intake (Department of Health, 1991) for energy, protein potassium, vitamin D and chloride. Results: None of the prescribed feeds met the estimated average requirements (EAR) for energy. The level of compliance varied for the other nutrients as shown in Table 1. Table 1. Percentage (n) of clients compliant with dietary reference values (EAR/lower reference nutrient intake) Nutrient % Compliance Number compliant Energy 0 0/75 Protein 21 16/75 Potassium 56 42/75 Vitamin D 0 0/75 Chloride 80 60/75 Discussion: Because the energy requirement was often low in this group, and the feed prescribed accordingly, the intake of other nutrients was compromised. Commercial feeds are not always available to meet this client group's needs therefore prescribers must be aware of the potential for deficiencies to occur and it may be necessary to supplement feeds. It was possible that clients needing a very much reduced energy intake may not require as much as the reference nutrient intake for nutrients but there is no research to support this. Conclusions: The survey showed that the adults and children do not meet the EAR for energy and do not meet the reference nutrient intake/lower reference nutrient intake for some nutrients. Regular assessment, monitoring and follow-up with appropriate supplementation is necessary to ensure a nutritionally adequate intake.

Effects of a school-based intervention on adherence of 7–9-year-olds to food-based dietary guidelines and intake of nutrients

To assess the effects of a school-based intervention on the diets of 7-9-year-olds. Dietary intake of children in second and fourth grades was assessed with 3d weighed dietary records in autumn 2006 and autumn 2008, before and after a school-based intervention that started in the middle of second grade, and compared with control schools with no intervention. The diet was evaluated by comparison with food-based dietary guidelines (FBDG) and reference values for nutrient intake. The intervention aimed at several determinants of intake: knowledge, awareness, preferences/taste, self-efficacy and parental influence. Nutrition education material was developed for the intervention and implemented in collaboration with teachers. The main focus of the intervention was on fruit and vegetable intake as the children's intake was far from meeting the FBDG on fruit and vegetables at baseline. Elementary schools in Reykjavik, Iceland. Complete dietary records were available for 106 children both at baseline and follow-up. Total fruit and vegetable intake increased by 47 % in the intervention schools (mean: 61.3 (sd 126.4) g/d) and decreased by 27 % in the control schools (mean: 46.5 (sd 105.3) g/d; P < 0.001). The majority of the children in the intervention schools did still not meet the FBDG on fruits and vegetables at follow-up. Fibre intake increased significantly in the intervention schools, as well as that of potassium, magnesium, beta-carotene and vitamin C (borderline). The school-based intervention in 7-9-year-olds was effective in increasing fruit and vegetable intake, by 47 % increase from baseline, which was mirrored in nutrient intake.

Adherence to food-based dietary guidelines and evaluation of nutrient intake in 7-year-old children

To evaluate the diet of 7-year-old children by comparison with food-based dietary guidelines (FBDG) and reference values for nutrient intake. Food and nutrient intake was assessed by 3 d weighed dietary records of 7-year-olds in six randomly chosen schools in Reykjavik, Iceland. Height and weight were measured. The diet of 165 children (62 % of sample) was evaluated by the Icelandic FBDG and the Nordic reference values (NRV) for nutrient intake. Six randomly chosen schools in Reykjavik, Iceland. The FBDG on fruits and vegetables was reached by less than 20 % of the children. A total of 52 % reached the FBDG to eat fish twice a week and 41 % to use vitamin D supplement. The FBDG on dairy was reached by 66 % of the children. Mean intake of SFA gave 13.9 % of the total energy intake (E%), which is higher than the NRV, 9.3E% of MUFA and 3.8E% of PUFA, both lower than the NRV (for all differences P < 0.001). Added sugar gave 12.1E%, which exceeds the upper level (P < 0.001). Fibre intake was 2.1 g/MJ and lower than the NRV (P < 0.001). Mean intake of micronutrients was above the recommended intake (RI), except for iodine, 109.0 microg/d, and vitamin D, 6.1 microg/d, which was lower than the RI (P = 0.006 and P < 0.001, respectively). Fruit, vegetable, fish and dairy, as well as vitamin D supplement, need to be increased in the diet of 7-year-old children to reach the FBDG and the reference values for nutrient intake. Dietary changes to increase the quality of fat and carbohydrate are needed as well.

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

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

CONCEPTS IN HUMAN NUTRITION AND ANIMAL FEEDING New Reference Values for nutrient intake in Germany, Austria and Switzerland (DACH-reference values)

In accordance to their very good collaboration through decades especially at the “3 Countries Meetings” the Nutrition Societies of Germany, Austria and Switzerland (D, A, CH) decided to prepare new Reference Values for nutrient intake as a joint edition in the year 2000. The Reference Values consist of two parts: Part 1, Nutritive aspects of nutrients. Part 2, Preventive aspect of nutrient and food components. The Reference Values presented should protect almost all individuals of the respective group against potential damage to health from their diet and provide a basis for full functional capacity. In detail recommendations, estimates or guideline values are presented for the different nutrients. Total fat should not exceed 30% of energy, saturated fatty acids should not provide more than 10% of energy and polyunsaturated fatty acids 7% of energy with n-6 and n-3 fatty acids in a ratio of 5:1. Preventive aspect concern the prophylaxis of nutrition-related diseases.

Development of scores to measure the effects of nutrition counselling on the overall diet: A pilot study in children and adolescents.

An intervention study by documented dietary counselling was carried out in a sample of 9 children and adolescents (12-15 years) living in a full-time institution in Dortmund. Three weighed dietary records were collected over 3-7 days, one before and one after each of two individual nutrition counselling sessions, which were based on the recommended intake of food groups defined by the Optimized Mixed Diet (OMD), a quantitative preventive dietary conception for children and adolescents. As univariate dietary parameters (e.g., cholesterol intake), which are often used to show the effectiveness of nutrition counselling, do not take into account the multivariate complexitiy of nutrition, we developed 3 multivariate scores to measure the effectiveness of nutrition counselling. They are defined as: Recommended Food group change Score (RFS): Average change in the amounts of the deviations (%) from the reference food groups values (OMD = 100 %) before and after counselling taking into account the aim (eat mor/less) of the counselling session, exclusively based on the food groups addressed during counselling. Total Food group change Score (TFS): Average change in the amounts of the deviations (%) from the reference food group values (OMD = 100 %) before and after counselling based on all food groups consumed. Nutrient Improvement Score (NIS): Average change in the negative deviations (%) of 8 vitamins and 8 minerals from the German reference values for nutrient intake (Deutsche Gesellschaft für Ernährung (DGE) = 100 %) before and after counselling. On average, the intakes of the food groups mentioned during the first counselling session improved considerably (RFS = +36 %), the change in the intake of all food groups was small (TFS = +6 %) and the nutrient intakes did not improve (NIS = 0 %). From the second counselling session the values of the RFS was +10 %, of the TFS was +6% and of the NIS +3 %. This means that the success of counselling on one dietary criterion does not guarantee success on others. Our food and nutrient based scores together with a detailed food intake assessment give an example of multivariate measurements of nutrition counselling outcomes.