Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005) / Chapter Skim
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The overall project is a comprehensive effort undertaken by the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes (the DRI Committee) of the Food and Nutrition Board, Institute of Medicine, The National Academies, in collaboration with Health Canada (see Appendix B for a description of the overall process and its origins)
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, and the Adequate Intake (AI) -- are defined by specific criteria of nutrient adequacy; the fourth, the Tolerable Upper Intake Level (UL)
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Estimated Average Requirement (EAR) : the average daily nutrient intake level estimated to meet the requirement of half the healthy individuals in a particular life stage and gender group.
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. Although a low intake of total water has been associated with some chronic diseases, this evidence is insufficient to establish water intake recommendations as a means of reducing the risk of chronic diseases.
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Examination Survey (NHANES III) indicate that serum osmolality, an indicator of hydration status, is maintained at a constant level over a wide range of total water intakes (i.e., serum osmolality is nearly identical for individuals in the lowest decile of reported intake compared with those in the highest decile of intake)
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from food. See Table S-1 for the median percent of total water intake from beverages (including drinking water)
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While consumption of beverages containing caffeine and alcohol have been shown in some studies to have diuretic effects, available information indicates that this may be transient in nature, and that such beverages contribute to total water intake. While the AI is given in terms of total water, there are multiple sources of such water, including moisture content of foods, beverages such as juices and milk, and drinking water.
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Moderate potassium deficiency, which typically occurs without hypokalemia, is characterized by increased blood pressure, increased salt sensitivity,2 an increased risk of kidney stones, and increased bone turnover (as indicated by greater urinary calcium excretion and biochemical evidence of reduced bone formation and increased bone resorption)
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. Available evidence indicates that this level of potassium intake should lower blood pressure, blunt the adverse effects of sodium chloride on blood pressure, reduce the risk of kidney stones, and possibly reduce bone loss.
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a No Tolerable Upper Intake Level is established; however, caution is warranted given concerns about adverse effects when consuming excess amounts of potassium from potassium supplements while on drug therapy or in the presence of undiagnosed chronic disease. b AI = Adequate Intake.
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. Sodium intake invariably rises with increased energy intake in physically active individuals, and this increase usually is enough to compensate for sweat sodium losses.
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Concerns have been raised that a low level of sodium intake adversely affects blood lipids, insulin resistance, and cardiovascular disease risk. However, at the level selected for the AI, the preponderance of evidence does not support this contention.
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c UL = Tolerable Upper Intake Level. Based on prevention of increased blood pressure.
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Because of the ability to self regulate water intake from fluids and foods by healthy people in temperate climates, a Tolerable Upper Intake Level (UL) was not set for water.
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/day. Several trials included sodium intake levels close to 1.5 g (65 mmol)
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The rise in blood pressure from increased sodium chloride intake is blunted in the setting of a diet high in potassium or a low-fat, mineral-rich diet; nonetheless, a dose-response relationship between sodium intake and blood pressure still persists. In nonhypertensive individuals, a reduced salt intake can decrease the risk of developing hypertension.
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and Dietary Reference Intakes: Applications in Dietary Planning (IOM, 2003) and described briefly in Chapter 8, when a Recommended Dietary Allowance (RDA)
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of men and women in the United States consumed dietary sodium at levels greater than the AI, and thus one would assume that intakes were "adequate," and thus sufficient to cover sodium losses. • More than 95 percent of men and 75 percent of women in the United States had sodium intakes that exceeded the UL, even when the amount of sodium added to foods during meals (table salt)
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RDA = Recommended Dietary Allowance EAR = Estimated Average Requirement AI = Adequate Intake UL = Tolerable Upper Intake Level a Evaluation of true status requires clinical, biochemical, and anthropomet ric data. b Requires statistically valid approximation of distribution of usual intakes.
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2002/2005. Dietary Reference Intakes for Energy, Carbohydrate, Cholesterol, Fat, Fatty Acids, Protein, Amino Acids, and Physical Activity.
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