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The National Academies of Sciences, Engineering, and Medicine convened a public workshop in September 2017 to explore the evidence for achieving global harmonization of methodological approaches to establishing nutrient intake recommendations. Participants reviewed current nutrient intake recommendations, discussed the feasibility of harmonizing approaches to setting such recommendations globally, examined the development of principles by which they may be applied in diverse contexts that relate to individuals or populations, or regulatory purposes, and examined perceptions and acceptance of nutrient intake recommendations by different stakeholders. This publication summarizes the presentations and discussions from the workshop.
Recommended intake levels for nutrients and other dietary components were designed initially to prevent nutrient deficiency diseases in a given population, and the original methodological approach used to derive intake values did not include consideration for other applications. However, with the increasing globalization of information and the identification of a variety of factors specific to different population subgroups (e.g., young children and women of reproductive age) that influence their nutritional needs, there has been increasing recognition of the need to consider methodological approaches to deriving nutrient reference values (NRVs) that are applicable across countries and that take into account the varying needs of different population subgroups. There is a need for guidance and recommendations about methodological approaches, as well as their potential for application to an international process for the development of NRVs, and particularly for young children and women of reproductive age. Harmonization of Approaches to Nutrient Reference Values: Applications to Young Children and Women of Reproductive Age examines these issues and makes recommendations for a unified approach to developing NRVs that would be acceptable globally.
Harmonized approaches to setting recommendations for safe and appropriate dietary intakes and nutritional interventions are critical to support the resolution of differences across countries in setting national and international nutrition standards; promote consistency in public and clinical health objectives; provide a mechanism for designing national and international food and nutrition policies; and enhance the transparency of national standards for trade and other regulatory actions that have economic, health, and safety implications. Consistent dietary intake recommendations cannot be made without first establishing a consistent approach to derive reference values for population-level nutrient intakes. This tool kit is designed to help global stakeholders, including those in low- and middle-income countries, participate more easily in the process of implementing, disseminating, and evaluating a consistent and homogeneous methodological approach to the nutrient reference value process.
Recommended intake levels for nutrients and other dietary components were designed initially to prevent nutrient deficiency diseases in a given population, and the original methodological approach used to derive intake values did not include consideration for other applications. However, with the increasing globalization of information and the identification of a variety of factors specific to different population subgroups (e.g., young children and women of reproductive age) that influence their nutritional needs, there has been increasing recognition of the need to consider methodological approaches to deriving nutrient reference values (NRVs) that are applicable across countries and that take into account the varying needs of different population subgroups. There is a need for guidance and recommendations about methodological approaches, as well as their potential for application to an international process for the development of NRVs, and particularly for young children and women of reproductive age. Harmonization of Approaches to Nutrient Reference Values: Applications to Young Children and Women of Reproductive Age examines these issues and makes recommendations for a unified approach to developing NRVs that would be acceptable globally.
Harmonized approaches to setting recommendations for safe and appropriate dietary intakes and nutritional interventions are critical to support the resolution of differences across countries in setting national and international nutrition standards; promote consistency in public and clinical health objectives; provide a mechanism for designing national and international food and nutrition policies; and enhance the transparency of national standards for trade and other regulatory actions that have economic, health, and safety implications. Consistent dietary intake recommendations cannot be made without first establishing a consistent approach to derive reference values for population-level nutrient intakes. This tool kit is designed to help global stakeholders, including those in low- and middle-income countries, participate more easily in the process of implementing, disseminating, and evaluating a consistent and homogeneous methodological approach to the nutrient reference value process.
This report summarizes a Nordic symposium on the current use and challenges in applying a dual risk assessment approach in the setting of nutrition recommendations. The symposium is timed with respect to the forthcoming update of the Nordic Nutrition Recommendations (NNR). At the symposium invited experts addressed the methodological framework for the dual risk approach for setting nutrition recommendations, including the terminologies and the criteria for the assessment. Case studies were presented to underline some of the specific current Nordic challenges, including use of supplements. Especially, the lack of data for risk assessment in nutrition was addressed with examples on extrapolations to subgroups such as children and the elderly and to energy and protein. Also, the development of nutrition risk assessment using nutrient intakes and chronic disease endpoints was addressed.
Since 1938 and 1941, nutrient intake recommendations have been issued to the public in Canada and the United States, respectively. Currently defined as the Dietary Reference Intakes (DRIs), these values are a set of standards established by consensus committees under the National Academies of Sciences, Engineering, and Medicine and used for planning and assessing diets of apparently healthy individuals and groups. In 2015, a multidisciplinary working group sponsored by the Canadian and U.S. government DRI steering committees convened to identify key scientific challenges encountered in the use of chronic disease endpoints to establish DRI values. Their report, Options for Basing Dietary Reference Intakes (DRIs) on Chronic Disease: Report from a Joint US-/Canadian-Sponsored Working Group, outlined and proposed ways to address conceptual and methodological challenges related to the work of future DRI Committees. This report assesses the options presented in the previous report and determines guiding principles for including chronic disease endpoints for food substances that will be used by future National Academies committees in establishing DRIs.
As essential nutrients, sodium and potassium contribute to the fundamentals of physiology and pathology of human health and disease. In clinical settings, these are two important blood electrolytes, are frequently measured and influence care decisions. Yet, blood electrolyte concentrations are usually not influenced by dietary intake, as kidney and hormone systems carefully regulate blood values. Over the years, increasing evidence suggests that sodium and potassium intake patterns of children and adults influence long-term population health mostly through complex relationships among dietary intake, blood pressure and cardiovascular health. The public health importance of understanding these relationships, based upon the best available evidence and establishing recommendations to support the development of population clinical practice guidelines and medical care of patients is clear. This report reviews evidence on the relationship between sodium and potassium intakes and indicators of adequacy, toxicity, and chronic disease. It updates the Dietary Reference Intakes (DRIs) using an expanded DRI model that includes consideration of chronic disease endpoints, and outlines research gaps to address the uncertainties identified in the process of deriving the reference values and evaluating public health implications.
Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate The Dietary Reference Intakes (DRIs) are quantitative estimates of nutrient intakes to be used for planning and assessing diets for healthy people. This new report, the sixth in a series of reports presenting dietary reference values for the intakes of nutrients by Americans and Canadians, establishes nutrient recommendations on water, potassium, and salt for health maintenance and the reduction of chronic disease risk. Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate discusses in detail the role of water, potassium, salt, chloride, and sulfate in human physiology and health. The major findings in this book include the establishment of Adequate Intakes for total water (drinking water, beverages, and food), potassium, sodium, and chloride and the establishment of Tolerable Upper Intake levels for sodium and chloride. The book makes research recommendations for information needed to advance the understanding of human requirements for water and electrolytes, as well as adverse effects associated with the intake of excessive amounts of water, sodium, chloride, potassium, and sulfate. This book will be an invaluable reference for nutritionists, nutrition researchers, and food manufacturers.