EURRECA has an excellent opportunity to develop tools to improve transparency on the approaches used in setting micronutrient recommendations, including the selection of criteria for adequacy, weighing of evidence, and interpretation of data.
The General Framework can serve as a basis for a systematic and transparent approach to the development and review of micronutrient requirements in Europe, as well as the decision making of scientific advisory bodies, policy makers and stakeholders involved in this process of assessing, developing and translating these recommendations into public health nutrition policy.
EURRECA is a Network of Excellence with the objective of addressing the problem of national variations in micronutrient recommendations and working towards a framework of advice to better inform policy-makers. It became apparent that the network needed a framework that puts the process of recommendation setting in the context of science, policy and society.Although variability in recommendations originates from the scientific evidence-base used and its interpretation (e.g. health outcomes, types and methods of evaluation of evidence, quantification of risk/benefit), the background information provided in the recommendation reports does not easily facilitate the disentangling of the relative contribution of these different aspects because of lack of transparency.The present report portrays the general framework (see Figure) that has been developed by and for EURRECA in order to make the process of setting up micronutrient recommendations explicit and transparent.In explaining the link from science to policy applications, the framework distinguishes four principal components or stages (see Figure). These stages are: a) Defining the nutrient requirements: A judgement about the (best) distribution(s) of the population requirement is necessary for estimating nutrient requirements. Many assumptions need to be made about the attributes of the population group. Furthermore, several factors (consumer behaviour as well as physiology) are to be included to characterize optimal health. b) Setting the nutrient recommendations: All available evidence is needed to formulate recommendations. Incorporating different endpoints provide the basis to formulate an optimal diet in terms of (non-)nutrients and food(group)s. c) Policy options: Policy options should be formulated on how the optimal diet can be achieved. They concern the advice of scientist and/or expert committees to the policy makers. Current policy options are setting up a task force, food based dietary guidelines, general health education, educational programme for specific group(s), voluntary or mandatory fortification, labelling, supplementation (general or for specific groups), inducing voluntary action in industry, legislation on micronutrient composition in food products, fiscal change, monitoring and evaluation of intake (via food consumption surveys) and/or nutritional status. d) Policy applications:Policies and planning, usually done by government, that lead to nutritional interventions or programmes. They usually require consideration of scientific, legal, regulatory, ethical and cultural issues, economic implications, and political and social priorities.This framework illustrates three dimensions of the process of setting (micro)nutrient requirements:1) The logical sequence of scientific thinking from setting physiological requirements for nutritional health leading to evidence-based derivation of Nutrient Intake Values. 2)In the early stages nutritional and epidemiological science is the dominant source and in the later stages evidence from consumer and soc...
Most European countries have national recommendations on micronutrient intakes for the elderly that reflect the level of intake that would meet the requirements of practically all healthy individuals in a specific population. They are used for assessing adequacy of dietary intakes and planning desirable dietary intakes (1) . For the elderly vitamin B 12 is a micronutrient of concern since inadequate intakes or poor status are prevalent in Europe and associations with severe health problems such as neurological diseases have been demonstrated (2) . To identify current recommendations on vitamin B 12 intake for the elderly, relevant reports from thirty-one European countries and organisations were collated. In addition, a questionnaire was distributed among key individuals and organisations in the different countries to obtain more information on the methods used to derive recommendations. Eight (groups of) countries and organisations derived de novo recommendations, based on the available scientific evidence.(3-10) Other countries adopted values from another source or a combination of sources (1) . In these eight 'original' reports recommendations on vitamin B 12 intake in Europe vary from 1.4 mg to 3.0 mg. This heterogeneity is confusing for policy-makers, health professionals, industry and consumers. A standard approach for deriving micronutrient recommendations throughout Europe has not yet been possible. National bodies use their own practices often involving small and select committees of experts. Furthermore, cultural and regional factors may affect their weighting of the scientific evidence and influence their decisionmaking.To pinpoint possible explanations for the variation among vitamin B 12 recommendations in Europe, different aspects of the methodology used for deriving them were compared, including: the process of converting physiological requirements into recommendations for populations and how these were defined; whether biomedical factors were considered; how adequacy was assessed; the quality of the evidence base; any other assumptions made.All eight reports expressed vitamin B 12 recommendations as the average physiological requirement + 2 SD. However, definitions of elderly individuals and consideration of their health status differed between reports. Upper age-groups (years) were defined as > 18, > 19, > 51, > 65, > 71 and > 75 and only the report of the DACH countries (Germany, Austria and Switzerland) gave a specific recommended intake for severe atrophic gastritis. Assessments of adequacy used different health outcomes and cut-off values were not the same. All reports assumed that requirements for vitamin B 12 do not change with age, but different calculations were made to estimate requirements. The scientific evidence base for vitamin B 12 recommendations also differed between reports, as judged by a comparison of references cited in three reports published between 2000 and 2003: France; the DACH countries; The Netherlands. Only one 'common' reference was included in all three reports.The ...
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