Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease (2017) / Chapter Skim
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8 The Process for Establishing Chronic Disease Dietary Reference Intakes
8 The Process for Establishing Chronic Disease Dietary Reference Intakes
Pages 243-252
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From page 243... ...
Chapters 4, 5, 6, and 7 offer recommendations and guiding principles to address the methodological and conceptual challenges when recommending chronic disease DRIs. Chronic disease, however, is only one of several types of indicators that are reviewed through the DRI process.
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From page 244... ...
and are convened based on a selection process that considers suggestions by stakeholders and potential conflicts of interests and biases following the policies of the National Academies. DRI committees are supported by FNB staff, who coordinate their work and ensure completion of the task and the publication of a report containing the DRIs as well as the scientific rationales, in the style of the National Academies reports.
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From page 245... ...
If two subcommittees are formed, the parent committee would then integrate the recommendations of each subcommittee into a single report. The committee chose not to use option 2 because the Federal Advisory Committee Act rules, which apply to committees of the National Academies and are meant to minimize external influences, require that committee members and staff keep deliberations confidential.
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From page 246... ...
The FNB or a government agency could appoint a new committee to establish reference values on the ba sis of chronic disease endpoints, or an existing group that is independent of the National Academies of Sciences, Engineering, and Medicine (e.g., expert panels from chronic disease societies or standing government advisory committees) could establish these reference values.
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From page 247... ...
When two DRI subcommittees are formed, they would approach the development of DRIs for a nutrient or a group of nutrients as separate processes, though they would use the same formally conducted systematic evidence review to complete their work.3 One subcommittee would recommend DRIs for all 22 life-stage groups that focus on the requirements for specific nutrients to ensure nutrient adequacy and prevent nutrient deficiency symptoms as well as prevent toxicities. The second subcommittee would examine the certainty of the scientific evidence on the relationship between the nutrients under review and chronic disease outcomes, keeping in mind the distinction that chronic disease DRIs are desirable but not essential.
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From page 248... ...
, that is, as acceptable range of intake, range of beneficial increased intakes, or range of beneficial decreased intakes. An alternative to the committee structure above would be to convene only one parent committee, with all the necessary expertise, but no subcommittees, to establish all DRIs.
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From page 249... ...
First, relatively little experience has been accrued in developing DRIs based on chronic disease, so it may be premature to change the current process before additional experience is gained. Second, the current scientific literature and study designs have tended to explore relationships substance by substance; that is, individual studies are more likely to document how a particular NOFS is related to various diseases rather than studying all the NOFSs that are related to a particular chronic disease.
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From page 250... ...
However, in the past DRIs were based on reaching adequacy and minimizing the potential for toxicity. As populations have changed their diet habits and more information about the prevalence of chronic disease and its risk factors has become available, there is a need to explore how nutrients contribute to chronic 4 The Dietary Guidelines Advisory Committees review the body of scientific and medical evidence in nutrition and prepare an Advisory Report for the Secretaries of the U.S.
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From page 251... ...
Although the United States and Canada have many years of experience in setting DRIs, integrating chronic disease as a focus is a fairly recent task; therefore the recommendations in this report should be revisited in the future as more practice and knowledge is gained. As chronic disease DRIs are set, there will be a need to develop guidance, possibly separate from the DRI reports themselves, on how these new DRIs could be used in dietary assessment and planning, especially in complex situations, such as a single NOFS with DRI ranges to lower risk of different chronic diseases. REFERENCES IOM (Institute of Medicine)
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