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1 Introduction and Workshop Overview
Pages 1-18

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From page 1...
... o Examine nutrient requirements in certain chronic conditions or acute phases for which emerging data suggest a contribution of nutrition status to disease outcomes. Consider the scientific evi dence needed to establish such relationships and discuss prin ciples about the relationship between nutrition requirements and specific diseases.
From page 2...
... The workshop will review the c currently available evidence used to determine potential nutritional requirements that are not encompassed within the normal population variation. The workshop discussions will also encompass the strengths and limitations of different types of evidence (e.g., clinical, non-clinical)
From page 3...
... 2 Materials from the workshop, including presentations and videos, can be found at http:// www.nationalacademies.org/hmd/Activities/Nutrition/ExaminingSpecialNutritional RequirementsinDiseaseStatesWorkshop/2018-APR-02.aspx (accessed June 14, 2018)
From page 4...
... Speakers during this session also provided some background and context for later sessions by defining special nutrient requirements and describing underlying biological processes of special nutrient requirements. Chapter 2 summarizes Session 2 presentations and discussions.
From page 5...
... Schneeman then reviewed the workshop objectives, putting them in the context of related National Academies work, including the DRI reports, the 2017 consensus study report Guiding Principles for Developing Dietary Reference Intakes Based on Chronic Disease (NASEM, 2017a) and the 2018 proceedings Nutrigenomics and the Future of Nutrition: Proceedings of a Workshop -- in Brief (NASEM, 2018)
From page 6...
... Regardless of the nutrient under consideration, DRI committees face a number of challenges in conducting these systematic reviews, including • selecting outcomes with the greatest value; which may be a chal lenge of particular importance for special nutrient requirements because the health outcome for a specific disease population may differ from that of the healthy population; 3This section summarizes information presented by Patsy Brannon. 4 For DRI values, see http://nationalacademies.org/HMD/Activities/Nutrition/SummaryDRIs/DRI-Tables.aspx (accessed June 6, 2018)
From page 7...
... Compared to the EARs and RDAs, a more cautious approach is taken in looking at the evidence for establishing ULs because randomized controlled trials (RCTs) are not typically conducted to identify toxicity health outcomes and, therefore, causality can be difficult to establish.
From page 8...
... • Because of an impairment in digestion, most individuals with cys tic fibrosis have an increased need for fat-soluble vitamins. Special nutrition requirements can be thought of as a distribution of nutritional requirements for a specific disease population outside of the DRI distribution for healthy populations (see Box 1-2)
From page 9...
... The distribution in yellow shows a lower nutrient require ment distribution, potentially requiring a lower nutritional reference value than the recommended dietary allowance for the healthy population. NOTE: DRI = Dietary Reference Intake; RDA = Recommended Dietary Allowance SOURCE: As presented by Patsy Brannon, April 2, 2018.
From page 10...
... He stated that this level of evidence sets a very high bar for the nutrition community, and that it exists for very few nutrient and chronic disease relationships. Modifiers of Nutrient and Food Needs The amount of nutrients required by an individual is determined by a number of physiological processes, including absorption, catabolism, excretion, metabolism, stability, transport, bio-activation, energetic state, and nutrient storage.
From page 11...
... Another issue in determining nutrient needs in a disease state is restoration of function that requires conditionally essen tial nutrients and tissue regeneration. A final consideration is that special nutritional requirements may optimize the number of stem cells avail Health Disease Prevention Disease Management Groups Primary–Secondary–Tertiary Acute–Chronic Whole Body Nutritional Status Normal Physiological Function Indicators Clinical Outcomes Co-morbidities Predictive Biomarkers Tissue Specific Nutritional Status Restoration of Function Tissue Regeneration Dietary Reference Intakes Special Nutritional Requirements 50% of the US adult population suffers from a chronic disease Prev.
From page 12...
... Stover suggested that special nutritional needs act through evolutionarily derived physiological mechanisms to restore nutritional adequacy and physiological function, thereby managing a specific disease state, not through off-target effects. Niacin is an example of a nutrient that at pharmacological doses (i.e., 10 times the DRI6)
From page 13...
... . Stover closed his presentation by noting that special nutritional requirements are an important area of research.
From page 14...
... Brannon envisioned a scenario in which a disease affects nutritional requirements or metabolism such that a bioactive food component might have an important role to play in managing those effects and it could influence nutrient distributions and other factors. Virginia Stallings, Children's Hospital of Philadelphia, followed up by suggesting the related idea of a special dietary pattern that could influence the response of nutrients because of small, synergistic effects with bioactive food components.
From page 15...
... Stover agreed that this question raises the intriguing issue of what a nutrient is and how to consider combinations of nutrients. It may not be possible to meet special nutritional requirements by diet alone.
From page 16...
... Another critical element, she states, is the strength of the recommendation that can be made based on that evidence. Translation to the Clinical Setting Concerns were raised regarding the translation of special nutritional requirements to patients when a regulatory path currently does not exist to get that treatment to patients.
From page 17...
... 2017a. Guiding prin ciples for developing Dietary Reference Intakes based on chronic disease.


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