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2 Conceptual Foundations of Nutrient Reference Value Development
Pages 21-40

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From page 21...
... , and the United States jointly with Canada (1994) initiated the new approach to setting nutrient intake recommendations based on a set of NRVs rather than a single recommended intake.
From page 22...
... . The ANR was to be derived from a normal distribution of nutrient intakes needed to achieve a specified health outcome for the reference population.
From page 23...
... compares terminology used to describe nutrient reference values currently in use around the world. NUTRIENT REFERENCE VALUES In this report, the committee describes the four core reference values: average requirement (AR)
From page 24...
... . Of these, ARs and ULs are critical for evaluating and planning nutrient intakes at the population level.
From page 25...
... , recommended nutrient intakes (RNIs) (World Health Organization/United Nations' Food and Agriculture Organization)
From page 26...
... Indeed, in the recently completed set of nutrient intake recommendations by the European Food Safety Authority (EFSA) , ARs were determined for only seven vitamins and three minerals owing to the fact that there were insufficient data to derive an AR with adequate certainty (EFSA, 2017a)
From page 27...
... . This is sometimes a challenge when planning nutrient levels for fortification, and the goal is to have a low proportion of a population with intakes less than the AR; yet, the ULs of some population subgroups, such as children consuming fortified cereals, are easily exceeded.
From page 28...
... Relevant components are further described and analyzed relative to the committee's task in Chapter 3. The Average Requirement and Upper Level: Core Components of the Organizing Framework The two core reference values used to derive all other reference values in the King and Garza (2007)
From page 29...
... population informed the National Academies' report Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease, which recommends that future DRI committees "characterize the health status of the population in terms of who is included and excluded for each DRI" (NASEM, 2017, p.
From page 30...
... that the systematic review should be a core component of the global harmonization of methodologies for NRVs (NASEM, 2018) , Joseph Lau argued that because human physiology is essentially the same across the same subpopulations around the world, the same evidence base can be used to inform nutrient intake recommendations.
From page 31...
... Other key steps of the systematic review process are described below. The EFSA Guidance Document (EFSA NDA Panel, 2010)
From page 32...
... Appraisal of internal and external validity (risk of bias)   Evaluation of risk of bias is an inherent step in the systematic review process that requires assessment of limitations to the internal and external validity of each study included in a systematic review (Higgins and Green, 2011)
From page 33...
... Also described below, in addition to being used for the goals of preventing deficiency and preventing risk of chronic disease, intake–response assessments are also used to determine safe upper intake levels. Preventing deficiency  Avoiding nutrient deficiency was the original basis for establishing NRVs.
From page 34...
... Determining a safe upper level of intake  NRVs usually include a safe upper intake level. As stated previously, ULs are not recommended intakes, rather they are estimates of the highest level of daily intake that convey no appreciable risk of adverse health effects (EFSA NDA Panel, 2006; King and Garza, 2007)
From page 35...
... Balance study  Similar to the factorial approach that can be used when a nutrient under review does not have a biomarker representative of actual nutrient level is the balance study. Balance studies measure input and excretion -- when they are equal it is assumed that the body is saturated.
From page 36...
... and women of reproductive age. CONCLUSION AND RECOMMENDATION The committee came to the following conclusion: The purpose of deriving NRVs is to ensure that the majority of a generally healthy population will have sufficient nutrient intake levels to prevent deficiency disease and avoid adverse effects of excessive intake.
From page 37...
... Recommendation 1. Nutrient reference expert panels should make two values their priority: specifically, the population average requirement (AR)
From page 38...
... 1998b. Dietary Reference Intakes: A risk assessment model for establishing upper intake levels for nutrients.
From page 39...
... 2009. Opportunities and challenges in conducting systematic reviews to support the develop ment of nutrient reference values: Vitamin A as an example.


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