Options for basing Dietary Reference Intakes (DRIs) on chronic disease endpoints: report from a joint US-/Canadian-sponsored working group

Abstract

Dietary Reference Intakes (DRIs) are used in Canada and the United States in planning and assessing diets of apparently healthy individuals and population groups. The approaches used to establish DRIs on the basis of classical nutrient deficiencies and/or toxicities have worked well. However, it has proved to be more challenging to base DRI values on chronic disease endpoints; deviations from the traditional framework were often required, and in some cases, DRI values were not established for intakes that affected chronic disease outcomes despite evidence that supported a relation. The increasing proportions of elderly citizens, the growing prevalence of chronic diseases, and the persistently high prevalence of overweight and obesity, which predispose to chronic disease, highlight the importance of understanding the impact of nutrition on chronic disease prevention and control. A multidisciplinary working group sponsored by the Canadian and US government DRI steering committees met from November 2014 to April 2016 to identify options for addressing key scientific challenges encountered in the use of chronic disease endpoints to establish reference values. The working group focused on 3 key questions: 1) What are the important evidentiary challenges for selecting and using chronic disease endpoints in future DRI reviews, 2) what intake-response models can future DRI committees consider when using chronic disease endpoints, and 3) what are the arguments for and against continuing to include chronic disease endpoints in future DRI reviews? This report outlines the range of options identified by the working group for answering these key questions, as well as the strengths and weaknesses of each option.

Emerging concepts on the role of epigenetics in the relationships between nutrition and health

“…More studies are needed that define the role of maternal nutrition in foetal programming and their long‐term affects with health and disease. With the increased interest in establishing nutrient intake recommendations based on chronic disease outcomes, the role of nutrition in chronic disease susceptibility must be understood from the first stages of gametogenesis through old age .…”

“…With the increased interest in establishing nutrient intake recommendations based on chronic disease outcomes, the role of nutrition in chronic disease susceptibility must be understood from the first stages of gametogenesis through old age [2].…”

The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review

“…After screening against the inclusion and exclusion criteria, the quality of the included papers was assessed with a quality-grading system, following the guidelines of a systematic review [38,39], and adapted from the protocols in the previous relevant studies [34][35][36][37]. In principle, it complies with the commonly adopted hierarchy of evidence in health research, i.e., systematic reviews/meta-analyses coming with the highest credibility, followed by randomised controlled trials (RCTs), cohort studies, case-control studies, cross-sectional studies, and case studies [90].…”

Safety of folic acid

“…The experience with folic acid fortification for NTD prevention has helped transform the paradigm for establishing nutrient requirements. Currently, there are ongoing initiatives to estimate dietary reference intakes using chronic disease end points, as opposed to functional indicators of nutrient deficiency or deficiency‐related disease . However, consideration of chronic disease prevention and other pathologies with complex etiology to establish nutrient requirements was less common in the 1990s.…”