Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease (2017) / Chapter Skim
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Other important uses are establishing reference points for monitoring dietary intake of populations, evaluating government food assistance 1 Dietary Reference Intakes are a group of six different standards: (1) Estimated Average Requirement (EAR)
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. The Options Report is the primary reference resource for this consensus study, which aims to develop guiding principles and recommendations to develop chronic disease DRIs.
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In this situation, the DRI committee might need to develop criteria for selecting appropriate disease indicators to establish multiple intake-response relations, methods to integrate multiple endpoints, and approaches to account for the inevitable inter-individual variability in the relations of interest. When should intake- Option 1: Establish reference intake values only for similar response data be populations.
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What should be the Option 1: Establish DRIs for individual or small groups of starting point of chronic interrelated food substances disease DRIs? Option 2: Establish DRIs for multiple food substances on the basis of a chronic disease endpoint.
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In making its recommendations, the committee assumed that the work of future DRI committees will be done within the context of the current DRI process (see Figure S-1) , in which a DRI committee will receive a thorough and rigorously implemented systematic review,2 will review the totality of the evidence about questions 1 and 2 above, and will recommend chronic disease DRIs, if appropriate.
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TEP = Technical Expert Panel; DRI = Dietary Reference Intake; AHRQ = Agency for Health Care Research and Quality; SR = Systematic Review a The Agency for Healthcare Research and Quality is listed here as the agency that, in the current DRI process, has been respon sible for the systematic review aspects of DRI development. b National Academies DRI committees are convened by and positioned with the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine and operate under the National Academies study committee guidelines, which include an external peer review process of the draft DRI report.
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In addition to providing recommendations, the committee developed guiding principles to support DRI committees as they make decisions about chronic disease DRIs. In implementing the recommendations, communication with users and development of guidance for appropriate application of the recommendations are essential.
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The ideal outcome used to establish chronic disease Dietary Reference Intakes should be the chronic disease of interest, as defined by accepted diagnostic criteria, including composite endpoints, when applicable. Surrogate markers could be considered with the goal of using the findings as supporting information of results based on the chronic disease of interest.
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. Although all the systems reviewed involve similar concepts, GRADE is recommended as the basis for DRI committee judgments about causal relationships between NOFS exposures and chronic diseases for the following reasons: (1)
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The committee recommends extrapolation of intake-response data for chronic disease Dietary Reference Intakes
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What Should Be the Different Types of DRIs Associated with Reduction in Chronic Disease Risk? The committee supports a variant of options 1 and 2 and notes that the traditional Tolerable Upper Intake Level (UL)
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If the increase in risk only occurs at intakes greater than the traditional UL, no chronic disease Dietary Reference Intake would be required, because avoiding intakes greater than the UL will avoid the chronic disease risk. What Are Acceptable Levels of Confidence in the Intake-Response Data?
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DRI committees will explore the decisions related to all DRIs (i.e., based on adequacy, toxicity, and chronic diseases) and, in some cases, harms and benefits could overlap.
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Because of the need for close coordination and exchange of ideas when setting Dietary Reference Intakes (DRIs) based on indicators of adequacy, toxicity, and chronic dis ease, one single National Academies of Sciences, Engineering, and Medicine parent committee should develop DRIs for the prevention of nutrient deficiencies and toxicities and for reducing the risk of chronic disease.
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When sufficient evidence exists to develop chronic disease Dietary Reference Intakes for one or more nutri ent or other food substances (NOFSs) that are interrelated in their causal relationships with one or more chronic diseases, a committee should be convened to review the evidence of their association with all selected diseases.
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In such cases, it is necessary to identify, disclose, and manage any potential conflicts of interest. Mechanisms to allow for interactions between the DRI committee and members representing both the technical expert panel and systematic review team, while also protecting against inappropriate influence on the systematic review methods, are strongly encouraged.
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Presented at the Workshop of the Committee on Development of Guiding Principles for the Inclusion of Chronic Disease Endpoints in Future Dietary Reference Intakes, January 9, 2017, Washington, DC. IOM (Institute of Medicine)
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