Defining Populations for
Dietary Reference Intake
A Letter Report
Standing Committee for the Review
of the Dietary Reference Intake
Food and Nutrition Board
Health and Medicine Division
Consensus Study Report
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and the US Department of Agriculture (Grant Agreement #59-0204-1-006). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-69440-7
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Defining populations for Dietary Reference Intake recommendations: A letter report. Washington, DC: The National Academies Press. https://doi.org/10.17226/26733.
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STANDING COMMITTEE TO REVIEW THE DIETARY REFERENCE INTAKE FRAMEWORK
JOHN W. ERDMAN JR. (Chair), Professor Emeritus, Department of Food Science & Human Nutrition, University of Illinois at Urbana-Champaign
M. R. C. GREENWOOD (Vice Chair), Distinguished Professor of Nutrition, University of California, Davis
STEPHANIE ATKINSON, Professor, Department of Pediatrics; Associate Member, Department of Biochemistry and Biomedical Sciences, Faculty of Health Science, McMaster University
SAI KRUPA DAS, Senior Scientist, Jean Mayer USDA Human Nutrition Research Center on Aging; Associate Professor, The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University
AMY HERRING, Distinguished Professor, Department of Statistical Science, Duke Global Health Institute, Department of Biostatistics and Bioinformatics, Duke University
NANCY KREBS, Professor of Pediatrics, Associate Vice Chair, Academic Affairs, Department of Pediatrics, University of Colorado School of Medicine
ALICE H. LICHTENSTEIN, Senior Scientist and Director of the Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging; Gershoff Professor of Nutrition Science and Policy, Friedman School, Tufts University
NADINE SAHYOUN, Professor, Department of Nutrition and Food Science, University of Maryland, College Park
VALERIE TARASUK, Professor, Department of Nutritional Sciences, Temerty Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto
LINDA VAN HORN, Professor and Chief, Nutrition Division, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
ELIZABETH A. YETLEY, Senior Nutrition Research Scientist, Retired, Office of Dietary Supplements, National Institutes of Health
ANN L. YAKTINE, Study Director
ALICE VOROSMARTI, Associate Program Officer
MELANIE ARTHUR, Senior Program Assistant
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This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
JANET KING, The University of California, Berkeley
RICHARD MATTES, Purdue University
MARIAN NEUHOUSER, Fred Hutchinson Cancer Research Center
KATHERINE TUCKER, The University of Massachusetts Lowell
BARBARA SCHNEEMAN, The University of California, Davis
LINDIWE SIBEKO, The University of Massachusetts Amherst
FRANCENE M. STEINBERG, The University of California, Davis
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by DIANE F. BIRT, Iowa State University, and CATHERINE E. WOTEKI, Iowa State
University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Current Health Status of the U.S. and Canadian Populations
4 QUESTIONS FROM THE FEDERAL DRI JOINT U.S.–CANADIAN WORKING GROUP
Question WG1: Who should be included in the “healthy population” definition to adequately characterize the population covered by the DRIs?
Question WG2: Is it assumed that subpopulations with risk factors for chronic diseases (such as overweight or obesity, high blood pressure, hypercholesterolemia, or prediabetes) are considered to meet the current definition since they do not meet the exclusion criteria listed above?
Question WG3: How should overweight and obesity be considered given the high prevalence of obesity?
Question WG4: Should a different term be considered other than “apparently healthy population” since the DRIs are developed to determine the recommended intake of
nutrients to meet the needs of the majority of the general population and the health status of this population has shifted?
Question WG5: How should, or can, evidence from populations that are not “apparently healthy” be used to develop the DRIs? What about data from populations with clinical disease?
Question WG6: How should this definition inform the use of the DRIs for their various purposes?
5 QUESTIONS FROM THE COMMITTEE TO REVIEW THE DRIs FOR ENERGY
Question EC1: Should a DRI committee approach identifying a general or healthy population based on inclusion or exclusion criteria?
Question EC2: What is the standing committee’s recommendation for managing limitations in data needed to support a rationale for recommendations?
Question EC3: If data on some subpopulations are limited, how do you determine when to use the data as a criterion to exclude that group from the defined general population?
Question EC4: Does the standing committee want to make a statement about using International Classification of Diseases (ICD) codes to exclude population groups in a DRI review?
Question EC5: Are extreme outliers included in the general population? What about normal body composition when body mass index (BMI) is less than or equal to 18.5?
Question EC6: Since the DRIs for energy are different from other nutrients, how should the committee manage limitations in data needed to support the rationale for a recommendation?