Dietary Reference Intakes for Energy (2023)

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Dietary Reference Intakes for Energy Committee on the Dietary Reference Intakes for Energy 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 Health Canada (Contract #4500431935), the National Institutes of Health (Contract #HHSN263201800029I/75N98021F00007), the U.S. Department of Agriculture (Contract #59-0204-1-005), and the U.S. Food and Drug Administration (Contract #75F40121C00075). 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-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/26818 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2023 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Dietary reference intakes for energy. Washington, DC: The National Academies Press. https://doi.org/10.17226/26818. PREPUBLICATION COPY: UNCORRECTED PROOFS 

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY: UNCORRECTED PROOFS 

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. Rapid Expert Consultations published by the National Academies of Sciences, Engineering, and Medicine are authored by subject-matter experts on narrowly focused topics that can be supported by a body of evidence. The discussions contained in rapid expert consultations are considered those of the authors and do not contain policy recommendations. Rapid expert consultations are reviewed by the institution before release. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY: UNCORRECTED PROOFS 

COMMITTEE ON DIETARY REFERENCE INTAKES FOR ENERGY ANNA MARIA SIEGA-RIZ (Chair), University of Massachusetts Amherst REGAN L. BAILEY, Texas A&M University, College Station ETHAN M. BALK, Brown University School of Public Health, Providence, Rhode Island SUSAN I. BARR, University of British Columbia, Vancouver, Canada LONEKE T. BLACKMAN CARR, University of Connecticut, Storrs (until May 9, 2022) NANCY F. BUTTE, Baylor College of Medicine, Houston, Texas SCOTT E. CROUTER, The University of Tennessee Knoxville AMY H. LUKE, Loyola University Chicago, Maywood, Illinois SUSAN B. ROBERTS, Tufts University, Boston, Massachusetts (until June 16, 2022) HEIDI J. SILVER, Vanderbilt University Medical Center, Nashville, Tennessee JANET A. TOOZE, Wake Forest School of Medicine, Winston Salem, North Carolina WILLIAM W. WONG, Baylor College of Medicine, Houston, Texas ELIZABETH A. YETLEY (Retired), National Institutes of Health, Bethesda, Maryland Consultants RICHARD TROIANO (Retired), National Institutes of Health, Bethesda, Maryland DAVID ALLISON, Indiana University School of Public Health-Bloomington CARMEN TEKWE, Indiana University School of Public Health-Bloomington ROGER ZOH, Indiana University School of Public Health-Bloomington STEPHANIE DICKINSON, Indiana University School of Public Health-Bloomington LILIAN GOLZARRI ARROYO, Indiana University School of Public Health-Bloomington AARON COHEN, Indiana University School of Public Health-Bloomington JOCELYN MINEO, Indiana University School of Public Health-Bloomington Health and Medicine Division Staff ANN L. YAKTINE, Study Director ALICE VOROSMARTI, Associate Program Officer MELANIE ARTHUR, Senior Program Assistant PREPUBLICATION COPY: UNCORRECTED PROOFS v 

PREPUBLICATION COPY: UNCORRECTED PROOFS 

Reviewers 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: JAMY D. ARD, Wake Forest University School of Medicine DEEPA HANDU, Academy of Nutrition and Dietetics STEVEN B. HEYMSFIELD, Louisiana State University System ANNA THALACKER-MERCER, University of Alabama at Birmingham MARIAN L. NEUHOUSER, Fred Hutchinson Cancer Center LEANNE REDMAN, Pennington Biomedical Research Center USHA RAMAKRISHNAN, Emory University A. CATHERINE ROSS, The Pennsylvania State University BARBARA SCHNEEMAN, University of California, Davis (Emerita) DALE A. SCHOELLER, University of Wisconsin-Madison STELLA LUCIA VOLPE, Virginia Polytechnic Institute and State University 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 ENRIQUETA C. BOND, Burroughs Wellcome Fund, 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. PREPUBLICATION COPY: UNCORRECTED PROOFS vii 

PREPUBLICATION COPY: UNCORRECTED PROOFS 

Preface This committee focused on updating the Dietary Reference Intakes (DRI) for energy for the U.S. and Canadian populations. The previous update occurred in 2002–2005 within a report that included DRIs for energy and macronutrients. This committee’s work is of critical importance given that the DRI for energy is widely used to provide guidance for maintaining energy balance in individuals of a defined age, sex, weight, height, and level of physical activity. For example, within health care settings, practitioners use these recommendations to counsel patients on how to attain or maintain an appropriate weight given certain health conditions. Health care practitioners also use the recommendations to advise pregnant women on dietary intake to support adequate weight gain during pregnancy and to advise lactating women on appropriate weight change in the postpartum period, topics that are also covered in registered dietitians’ counseling of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants. As another example, the school breakfasts and lunches served each school day to millions of students across the United States and Canada are based on these energy requirements in an effort to keep children healthy, growing, and in optimal states for learning. Although these recommendations have a margin of error inherent in any equation-based DRI, they provide a solid baseline and allow individuals and planners to monitor energy balance to enhance the general health of individuals and of the populations. In this revision of the DRI for energy, the committee’s work included two major changes. One was a change in the referent population to which the DRI can be applied. In an effort to be more inclusive of all individuals living in the United States and Canada—where a greater proportion of the populations are living with a chronic disease—the referent population is now the general population instead of the healthy population. We thank the DRI Standing Committee for their consultation on this matter, which led to the committee’s final decision to make this change. The second change was to build a more comprehensive doubly labeled water (DLW) database by using multiple sources, including the International Atomic Energy Agency (IAEA) and the Hispanic Community Health Study (SOLNAS). We thank Dr. John Speakman from IAEA and Dr. John Kunz from the National Heart, Lung, and Blood Institute for facilitating the committee’s use of these data. Furthermore, we are especially appreciative of the work conducted by the team at Indiana University School of Public Health-Bloomington (Dean David Allison, Dr. Carmen Tekwe, Dr. Roger Zoh, Stephanie Dickinson, Lilian Golzarri, Jocelyn Mineo, and Aaron Cohen) that performed the data management and statistical analyses to derive the equations for energy expenditure. The compilation of new DLW data combined with the data used in the Institute of Medicine’s 2002/2005 report on DRIs for energy and macronutrients greatly enhanced our ability to develop more accurate prediction equations for estimating total energy expenditure. We were fortunate to have the support of Cynthia Ogden at the Centers for Disease Control and Prevention and The Minh Luong and Dominque Ibañez at Statistics Canada in providing us with current data from national nutrition monitoring surveys for inclusion in the report. These data allowed the committee to assess current intakes and energy status among U.S. and Canadian life-stage groups and provided background information for evaluating the public PREPUBLICATION COPY: UNCORRECTED PROOFS ix 

x PREFACE health implications associated with deviations from the proposed Estimated Energy Requirement (EER). Several presenters provided the committee with cutting-edge, state-of-the-art information for it to consider as it conducted its work. The committee thanks John Jakicic, John Speakman, Kevin Hall, Rick Troiano, Leanne Redman, Kellie Casavale, and Kathryn Hopperton for taking the time to present their important work. As committee chair, I greatly appreciate the NASEM staff—Ann Yaktine, Alice Vorosmarti, Melanie Arthur, Katie Delaney, and Hoda Soltani—for the tremendous amount of professionalism and support provided to the committee in conducting its work. I am impressed by their dedication and high standards for using best practices to develop consensus reports containing policy recommendations. Lastly, I applaud the work of the committee members and our physical activity consultant, Dr. Rick Troiano, in coming together, volunteering their time, effort, expertise, and patience in taking on this important task and doing so in such a rigorous, respectful manner. Anna Maria Siega-Riz, Chair Committee on Dietary Reference Intakes for Energy PREPUBLICATION COPY: UNCORRECTED PROOFS 

CONTENTS SUMMARY 1 1 INTRODUCTION 15 Energy Intake and Expenditure in Humans 15 Background for the Study 17 The Committee’s Task and Approach 20 Organization of the Report 22 References 23 2 OVERVIEW OF THE DRI PROCESS 25 Overview of the Dietary Reference Intakes 25 The DRI Organizing Framework 25 Adapting the DRI Organizing Framework to Energy 27 References 28 3 METHODOLOGICAL APPROACH TO GATHERING EVIDENCE 29 Approach for Gathering Doubly Labeled Water Data 29 Approach and Process for Gathering Relevant Literature 30 References 32 4 FACTORS AFFECTING ENERGY EXPENDITURE AND REQUIREMENTS 33 Components of Energy Expenditure 35 Other Considerations 42 Findings and Conclusions 44 References 45 5 DEVELOPMENT OF PREDICTION EQUATIONS FOR ESTIMATED ENERGY REQUIREMENTS 53 Use of Doubly Labeled Water to Assess Energy Requirements 53 Acquisition of Doubly Labeled Water Data 55 Derivation of Total Energy Expenditure Prediction Equations 59 Statistical Modeling: Development of TEE Prediction Equations 61 Results 63 External Model Validation 73 Energy Costs of Growth, Pregnancy, and Lactation 75 Estimated Energy Requirements 80 Findings and Conclusions 85 References 86 PREPUBLICATION COPY: UNCORRECTED PROOFS xi 

xii CONTENTS 6 ASSESSING ENERGY INTAKES, PHYSICAL ACTIVITY, AND INDICATORS OF OVERWEIGHT AND OBESITY 91 Approach to Assessing Energy Intakes and Physical Activity Expenditures 91 Methods for Assessing Energy Intake 92 Data on Validity from Studies with DLW for Energy Intake Across the Life Course 94 Methods for Assessing Physical Activity 95 Description of U.S. and Canadian National Surveys 97 Comparison of Energy Intake and Expenditure Among U.S. and Canadian Populations 99 Indicators of Body Weight and Adiposity 103 Findings and Conclusions 114 References 116 7 APPLICATIONS OF THE DIETARY REFERENCE INTAKES FOR ENERGY 121 Planning Energy Intakes 121 Assessing Adequacy of Energy Intakes 139 Comparison to 2005 DRIs 144 Findings and Conclusions 147 References 148 8 RISK CHARACTERIZATION AND PUBLIC HEALTH IMPLICATIONS 151 Chronic Disease Risks Associated with Overweight and Obesity 151 Considerations for Individuals with Special Needs 162 Findings and Conclusions 164 References 166 9 RESEARCH RECOMMENDATIONS 171 Factors Affecting Energy Requirements 171 Energy Metabolism in Special Population Groups 171 Weight Change and Energy Metabolism 172 Application of the EER to Individuals and Population Groups 173 APPENDIXES A Abbreviations 175 B Committee Member Biographies 177 C Open Session Agendas 183 D Literature Search Strategies and Results 185 E Key Questions and Eligibility Criteria 209 F AMSTAR 2 Tool 225 G Data Analysis Report 229 G Addendum: Details of Redefining of the TEE Model 259 H Characteristics of the DLW Database 261 PREPUBLICATION COPY: UNCORRECTED PROOFS 

CONTENTS xiii I Characteristics of the DLW Validation Studies 289 J Summary of Data Extracted from Systematic Reviews and other Reviewed Literature 291 K Interview Processes Used in National Surveys 403 L National Survey Data from the United States and Canada 407 M Estimated Energy Requirements by Body Weight Status 431 SUPPLEMENTAL APPENDIXES1 N DLW Data Codebook O Data Preparation and Preliminary Descriptive Statistics P Clean Analysis Q Multiple Imputation GLM Results R Performance Report S List of IAEA Studies with Inclusion/Exclusion T IOM Data Extracted from 2002/2005 Report U External Validation Data V SAS Code for Importing, Harmonizing, and Merging Data W SAS Code for Multiple Imputation and Models X National Survey Data: Dietary Intakes of Energy Y National Survey Data: Body Weight and Adiposity 1 Supplemental appendixes are available at https://nap.nationalacademies.org/catalog/26818. PREPUBLICATION COPY: UNCORRECTED PROOFS