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5. Examples of Planning for Groups
Pages 107-132

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From page 107...
... The final two examples discuss the problem of planning interventions designed to change the shape of the usual intake distribution of one or more nutrients in a targeted population group. It is often difficult to plan cliets that will achieve exactly the clesireci effect.
From page 108...
... an assisted living facility for seniors and (2) school nutrition programs, present the principles described in Chapter 3 for shifting the distribution of usual intakes.
From page 109...
... If such comparable usual intake ciata are not available, then the only option may be to use usual intake distributions from national surveys such as the Continuing Survey of Food Intakes by Inclivicluals (CSFII) or the Third National Health and Nutrition Examination Survey (NHANES III)
From page 110...
... . Because ciata on the usual nutrient intake distributions of the residents are not available, other sources must be used to estimate the target usual nutrient intake distribution.
From page 111...
... Accordingly, the target intake distributions shift up by 0.26 ma, by 0.42 ma, and by 0.7 mg using NHANES III, CSFII, and the Boston survey, respectively. In each case the target usual nutrient intake distribution would leaci to the accepted prevalence of inacloquacy.
From page 112...
... In the current example, although the baseline intakes at the 10th percentile and the meclian differ among the three surveys, the estimates of the meclians of the target usual intake distributions are quite similar, as shown in Table 5-2. Assuming that a 10 percent prevalence of intakes below the EAR was consiclereci acceptable, a meclian intake for vitamin B6 of 1.7 to 1.8 mg/ciay would be the planning goal.
From page 113...
... Thus, the planner might aim for a menu that offers a choice of meals with a nutrient content range that includes, or even exceeds, the meclian of the target usual nutrient intake distribution.
From page 114...
... Planners would simply examine the distributions of usual nutrient intake at breakfast and lunch and attempt to provide school meals that would result in these same usual intake distributions. Since the school nutrition programs, however, have nutritional objectives such as safeguarding the health of the nation's children through the provision of nutritionally acloquate meals in school (as stated in the language of the federal legislation)
From page 115...
... For vitamin A, however, if the acceptable group prevalence of inacloquacy is set at 2 to 3 percent rather than the current ~ to 10 percent, planners would aim to shift the usual intake clistribution by about 80 ,ug retinal activity equivalents (RAE) so only 2 to 3 percent are below the EAR, resulting in a target median intake of 854 ,ug RAE.
From page 116...
... The first of these options is consistent with the way in which the school nutrition programs currently operate, where the amount offered in the school meals is a specified proportion of the RDAs. Implementing this option in the case of vitamin A, for example, would entail prorating the target usual intake distribution, with the target meclian intake of 854 ,ug RAE, in such a way that a certain proportion is consumed at breakfast and at lunch.
From page 117...
... As in most of the examples in this chapter, ciata used here are real ciata, in this case collected in the 1994-1996 Continuing Survey of Food Intakes by Inclivicluals. Intake distributions of vitamin C and of energy for the three subgroups were acljusteci using the Iowa State University method (IOM, 2000a; Nusser et al., 1996~.
From page 118...
... , so that the proportion of target usual intakes below the EAR of 75 mg/ciay is now about 3 percent. The target meclian intake is now 144 mg/ciay.
From page 119...
... and set planning goals for the whole group. Ensure that intakes of the other subgroups wiR not be above the Tolerable Upper Intake [ever (UT)
From page 120...
... Obtain the target usual vitamin C intake distribution. The first step in the nutrient density distribution approach is similar to the first step in the simple nutrient density approach.
From page 121...
... Given a target nutrient intake distribution and a usual energy intake distribution. it is now possible to derive the target nutrient density intake distribution tor each subgroup.
From page 122...
... Adolescent Boys. In the case of boys age ci 14 to 18 years, the target nutrient density intake distribution has a meclian of 52 mg of vitamin C/l,OOO kcal, and Sth and 95th percentiles of 26 and 112 ma/ 1,000 kcal, respectively.
From page 123...
... Because the nutrient density clistribution approach accounts for variability in energy intakes, it is more likely to achieve planning goals. INTERVENTIONS THAT MAY CHANGE THE SHAPE OF THE INTAKE DISTRIBUTION: NUTRIENT SUPPLEMENTATION Some planning applications involve interventions that aim to mollify food or nutrient intakes.
From page 124...
... Assuming that the usual intake distribution floes not change its shape, the meclian intake would be the existing meclian intake + 2.6 mg (8.8 mg + 2.6 mg = 11.4 mg)
From page 125...
... The important conclusion from this example of planning is that an intervention to change usual intakes through supplementation can be difficult to design and implement. In a free-living population, not every person can be expected to consistently take a supplement (or a given food or food group rich in a specific nutrient)
From page 126...
... Regulations on food fortification differ between Canada and the United States, with voluntary fortification permitted in the United States. Regardless of whether fortification is mandatory or voluntary, if it is intencleci to achieve public health goals, then it is often necessary to "target" the fortification.
From page 127...
... The approach presented below involves mocleling and estimating the effects of a mock fortification effort by using ciata on foocis and nutrients consumed and then calculating the change in nutrient intake after the foocis are fortified. The preclicteci benefits and risks associated with the fortification can be assessed through application of assessment methods baseci on the Estimated Average Requirement (EAR)
From page 128...
... ciata suggests that about 15 percent have intakes below 300 ,ug RAE/ciay and hence have intakes apparently inacloquate to meet their own functional requirements. The same ciata suggest that about 44 percent may have intakes inacloquate to provide minimal stores of vitamin A
From page 129...
... declines from 44 percent at no fortification to 24 TABLE 5-7 Apparent Benefits and Potential Risks Associated with the Aciclition of Vitamin A to all Fluid Milk as a Function of Level of Aciclition, Women 19-50 Years of Age Prevalence of Inadequate Intakesb (below the EAR) Prevalence of Potentially Excessive IntakesC Level of Additiona % < EAR % < EAR % > UL (Pg/100 ml)
From page 130...
... without fortification, the aciclition of more vitamin A to milk would have a negligible effect on prevalence of this criterion of inacloquate intake. On the other hanci, the potential detrimental effect with fortification is TABLE 5-8 Apparent Benefits and Potential Risks Associated with the Aciclition of Vitamin A to all Fluid Milk as a Function of Level of Aciclition, Boys 9-13 Years of Age Prevalence of Inadequate Intakesb (below the EAR)
From page 131...
... Figure 5-1 summarizes the benefits to adult women by the declining percentage with inacloquate intake and the increasing potential risk to boys 9 to 13 years of age by the increasing percentage over the UL. Baseci on these results, planners would have to consider the preclicteci potential risk to boys 9 to 13 years of age and the preclicteci benefits to the target group of adult women before reaching a decision on whether to fortify and at what 50 40 30ct ct ~ 20Cal 10OBenefit to women: preserve liver stores Benefit to women: preserve function ma_ _ ~— l by__ .~ Risk to boys of excess ~_ _ 0 50 100 150 200 250 300 Level of Addition (,ug/100 ml)
From page 132...
... However, with voluntary fortification such as what is currently the practice in the United States, as the number of fortified foocis increases, it becomes extremely difficult to run meaningful mock fortification scenarios. In aciclition, it has not been possible to keep food composition ciatabases current with regard to branci-specific fortified foocis, and not all nutrient composition databases in the United States are clesigneci to do so.


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