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Gurugubelli VS, Fang H, Shikany JM, Balkus SV, Rumbut J, Ngo H, Wang H, Allison JJ, Steffen LM. A review of harmonization methods for studying dietary patterns. SMART HEALTH (AMSTERDAM, NETHERLANDS) 2022; 23:100263. [PMID: 35252528 PMCID: PMC8896407 DOI: 10.1016/j.smhl.2021.100263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Data harmonization is the process by which each of the variables from different research studies are standardized to similar units resulting in comparable datasets. These data may be integrated for more powerful and accurate examination and prediction of outcomes for use in the intelligent and smart electronic health software programs and systems. Prospective harmonization is performed when researchers create guidelines for gathering and managing the data before data collection begins. In contrast, retrospective harmonization is performed by pooling previously collected data from various studies using expert domain knowledge to identify and translate variables. In nutritional epidemiology, dietary data harmonization is often necessary to construct the nutrient and food databases necessary to answer complex research questions and develop effective public health policy. In this paper, we review methods for effective data harmonization, including developing a harmonization plan, which common standards already exist for harmonization, and defining variables needed to harmonize datasets. Currently, several large-scale studies maintain harmonized nutrient databases, especially in Europe, and steps have been proposed to inform the retrospective harmonization process. As an example, data harmonization methods are applied to several U.S longitudinal diet datasets. Based on our review, considerations for future dietary data harmonization include user agreements for sharing private data among participating studies, defining variables and data dictionaries that accurately map variables among studies, and the use of secure data storage servers to maintain privacy. These considerations establish necessary components of harmonized data for smart health applications which can promote healthier eating and provide greater insights into the effect of dietary patterns on health.
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Affiliation(s)
| | - Hua Fang
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, 01655, Massachusetts, USA
- Corresponding author. Tel.: +0-508-910-6411;
| | - James M Shikany
- Division of Preventive Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, 35294, Alabama, USA
| | - Salvador V Balkus
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
| | - Joshua Rumbut
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, 01655, Massachusetts, USA
| | - Hieu Ngo
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
| | - Honggang Wang
- University of Massachusetts Dartmouth, 285 Old Westport Rd, North Dartmouth, 02747, Massachusetts, USA
| | - Jeroan J Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 55 N Lake Ave, Worcester, 01655, Massachusetts, USA
| | - Lyn M. Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, 55455, Minnesota, USA
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Smith ER, He S, Klatt KC, Barberio MD, Rahnavard A, Azad N, Brandt C, Harker B, Hogan E, Kucherlapaty P, Moradian D, Gernand AD, Ahmadzia HK. Limited data exist to inform our basic understanding of micronutrient requirements in pregnancy. SCIENCE ADVANCES 2021; 7:eabj8016. [PMID: 34678054 PMCID: PMC8535830 DOI: 10.1126/sciadv.abj8016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
Women and pregnant people have historically been underrepresented in research; this may extend to the basic research informing nutrient reference values, such as the United States’ and Canada’s Dietary Reference Intakes (DRIs). After screening the DRI reports for 23 micronutrients, we extracted metadata from 704 studies. Women were excluded in 23% of studies, and they accounted for a smaller proportion of the sample size (29%). Pregnant or lactating people were included in 17% of the studies. Studies that used rigorous design elements, such as controlled feeding and stable isotope studies, were the most likely to include men only. The majority of studies (>90%) did not report race and ethnicity. Although nutrient reference values are intended for use in the general population, we find that the basic science informing these values may not be generalizable. We call urgently upon funders and researchers to address fundamental gaps in knowledge with high-quality research.
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Affiliation(s)
- Emily R. Smith
- Department of Global Health, The Milken Institute School of Public Health, The George Washington University, Washington , DC 20052 USA
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Siran He
- Department of Global Health, The Milken Institute School of Public Health, The George Washington University, Washington , DC 20052 USA
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Kevin C. Klatt
- USDA Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Matthew D. Barberio
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Ali Rahnavard
- Computational Biology Institute, Departments of Biostatistics and Bioinformatics, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
| | - Negeena Azad
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Carolyn Brandt
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Bethany Harker
- Department of Global Health, The Milken Institute School of Public Health, The George Washington University, Washington , DC 20052 USA
| | - Emily Hogan
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Padmini Kucherlapaty
- Department of Global Health, The Milken Institute School of Public Health, The George Washington University, Washington , DC 20052 USA
| | - Dina Moradian
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052 USA
| | - Alison D. Gernand
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA 16801, USA
| | - Homa K. Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
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Wiley AS. Pearl lecture: Biological normalcy: A new framework for biocultural analysis of human population variation. Am J Hum Biol 2021; 33:e23563. [PMID: 33458923 DOI: 10.1002/ajhb.23563] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 12/31/2022] Open
Abstract
Biological normalcy is a new analytical framework for understanding the bi-directional relationships between the biology of populations and cultural norms. Populations are characterized by statistical distributions-that is, measures of central tendency and variance-for biological traits, and these co-exist in societies with ideas about what constitutes "normal" human bodies, that is, normative views about what bodies "should" be like. While statistical norms may carry no explicit evaluative weight, the question is how they are related to judgments about what is "normal" or "abnormal." In a 1947 paper, Margaret Mead recognized their potential relationship: "normal…may refer to the statistically usual in the culture-usually without any recognition that this is culturally relative-so that the statistically usual is identified with the basically human…." Despite her observations over 70 years ago, little has been done on this topic, yet such work promises new insights into the relationship between culture and biology, here described at the population level, rather than as individual genetic characteristics. Using examples of sex/gender, race/ethnicity, age, and my work on human variation in the ability to drink milk, I outline the ways in which statistical norms may: influence individuals' perceptions of what is "normal" (Mead's "basically human"); lead to normative judgments about what human biology "should" be ("ethno-biocentrism") that are reinforced by biases in discourse about human variation; and potentially feedback to mold the biological characteristics of a population.
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Affiliation(s)
- Andrea S Wiley
- Department of Anthropology, Indiana University, Bloomington, Indiana, USA
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Yaktine AL, King JC, Allen LH. Why the Derivation of Nutrient Reference Values Should be Harmonized and How It Can be Accomplished. Adv Nutr 2020; 11:1102-1107. [PMID: 32379857 PMCID: PMC7490149 DOI: 10.1093/advances/nmaa048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/14/2022] Open
Abstract
The adoption of a panel of Nutrient Reference Values (NRVs) in place of a single recommended intake allowed for assessment of nutritional adequacy and safe upper intake levels for nutrients on a population level and for individuals. The Average Requirement (AR) and Tolerable Upper Intake Level (UL) comprise 2 core NRVs needed to obtain accurate, comparable estimates of population-level nutrient intakes, which are necessary to plan and evaluate nutrition support programs globally. Harmonizing the derivation of NRVs, particularly the AR and UL, is essential to ensure inclusion of all countries, whether high-, middle-, or low-income, in the process and to improve access for all users to the tools and data needed to carry it out. The NRV process today is more rigorous and transparent than the first derivation of DRIs because of adoption of systematic reviews and bias assessment methodologies, updated food and nutrient databases, data on cultural and context-specific dietary patterns, and better metabolic markers of nutritional status. A proposed framework for the derivation of NRVs builds on available methodologies to support the NRV process; however, this is not sufficient to achieve harmonization of the process. Fundamental to moving forward toward harmonization is removing existing barriers, including limited access to resources and databases and variance in terminology used to identify specific NRVs; adoption of more rigorous and transparent methodologies, including chronic disease endpoints, in the review process; and creating a central repository for easily accessible evidence. Chief among the barriers to harmonization is a willingness of global bodies to support an agreed-upon approach to the derivation process. Improving access to tools and data resources and providing guidance and support to encourage their adoption are critical to achieving harmonization of the NRV process. The factorial approach for calculating a nutrient requirement is described as the sum of total endogenous nutrient loss (endogenous fecal, urinary, integumental, seminal, menstrual) divided by its bioavailability or fractional absorption.
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Affiliation(s)
- Ann L Yaktine
- The National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA,Address correspondence to ALY (e-mail: )
| | - Janet C King
- University of California at Berkeley and Davis, Berkeley, CA, USA
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Carr AC, Lykkesfeldt J. Discrepancies in global vitamin C recommendations: a review of RDA criteria and underlying health perspectives. Crit Rev Food Sci Nutr 2020; 61:742-755. [PMID: 32223303 DOI: 10.1080/10408398.2020.1744513] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The concept of a 'recommended dietary allowance' (RDA) and similar terms describing the daily intake of essential nutrients recommended for healthy individuals is widely used by various health authorities around the world. For vitamin C, however, there remain significant discrepancies in the criteria used to establish dietary recommendations and consequently, global recommendations for daily vitamin C intake vary by more than five fold. While it appears that the scientific data underlying the recommendations are more or less the same, the interpretation differs considerably. Moreover, although a number of the assumptions used in e.g. the body pool estimates of the 1960s and 1970s have later been proven wrong and give rise to significant underestimations, these data are still used as the main support of several recommendations. Aspects that modify vitamin C requirements, such as gender, age, pregnancy, lactation, and smoking, have been taken into consideration by many but not all regulatory authorities, and are thus subject of debate. In contrast, body weight, a significant predictor of vitamin C status and requirement, has not been taken into consideration with respect to vitamin C recommendations, even in the face of the looming global obesity pandemic. The present review examines the discrepancies in vitamin C dietary recommendations of international authorities and critically discusses representative examples of criteria and the underlying health perspectives used to derive current recommended intakes of vitamin C. New biological signatures of vitamin C nutriture are also explored with regard to their potential use for future updates of dietary recommendations.
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Affiliation(s)
- Anitra C Carr
- Nutrition in Medicine Research Group, University of Otago, Christchurch, New Zealand
| | - Jens Lykkesfeldt
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ironing out the Iron Requirements of Children and Adolescents. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Vitamin D supplementation after the second year of life: joint position of the Committee on Nutrition, German Society for Pediatric and Adolescent Medicine (DGKJ e.V.), and the German Society for Pediatric Endocrinology and Diabetology (DGKED e.V.). Mol Cell Pediatr 2019; 6:3. [PMID: 31062205 PMCID: PMC6502918 DOI: 10.1186/s40348-019-0090-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/11/2019] [Indexed: 12/16/2022] Open
Abstract
Background Low vitamin D serum concentrations have been associated with rickets and other disorders in observational studies. Since vitamin D serum concentrations in children and adolescents are frequently below reference values, it is debated whether vitamin D should be supplemented after infancy. Methods The effects of vitamin D supplementation in children > 2 years of age are analyzed based on a literature review of randomized controlled trials (RCTs). Results Vitamin D supplementation can potentially reduce the risk for influenza infections and improve asthma bronchiale exacerbation; however, it has no impact on asthma bronchiale severity. Vitamin D supplementation has no relevant effect on attention-deficit/hyperactivity disorders, cardiac failure, hypertension, or incidence of type II diabetes mellitus. Vitamin D supplementation has no effect on the rate of multiple sclerosis relapses, but on the number of new lesions detected by MRI. For other endpoints, RCTs are lacking. Conclusion Based on currently available studies, routine vitamin D supplementation is not be recommended for children aged > 2 years, even when they have serum concentrations below reference values. Routine vitamin D supplementation is not recommended in children who do not have risk factors and chronic diseases which are associated with calcium or vitamin D resorption disorders.
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Pike V, Zlotkin S. Excess micronutrient intake: defining toxic effects and upper limits in vulnerable populations. Ann N Y Acad Sci 2018; 1446:21-43. [PMID: 30569544 DOI: 10.1111/nyas.13993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/21/2018] [Accepted: 11/06/2018] [Indexed: 12/17/2022]
Abstract
Excessive micronutrient intake causes a variety of adverse health effects, depending on dose and duration. The risk of excess intake carries significant implications for micronutrient delivery interventions, particularly when such programs are overlapping. To minimize risk and provide public health guidance, several countries and the Food and Agriculture Organization of the United Nations/World Health Organization have set upper intake levels (ULs) for various life-stage populations using the risk assessment framework. However, there is a lack of international consensus on the actual ULs due to variability in application of this framework and a scarcity of evidence from which to draw upon, especially for children. Often ULs for children are established through a downward weight-based extrapolation from adult ULs, which is not always appropriate. The published ULs of nine organizations are compared, recent population nutrient intake evidence is presented, and the toxic effects of key minerals and vitamins are reviewed. Finally, the evidence for toxicity and setting of ULs for each nutrient is discussed including a comment on our degree of confidence in the strength of existing individual ULs. Challenges with risk assessment and opportunities for strengthening the definition of ULs are discussed.
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Affiliation(s)
- Vanessa Pike
- The Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stanley Zlotkin
- The Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,The Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,The Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
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Fairweather-Tait SJ, de Sesmaisons A. Approaches used to estimate bioavailability when deriving dietary reference values for iron and zinc in adults. Proc Nutr Soc 2018; 78:1-7. [PMID: 30049292 DOI: 10.1017/s0029665118000484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This review aims to describe approaches used to estimate bioavailability when deriving dietary reference values (DRV) for iron and zinc using the factorial approach. Various values have been applied by different expert bodies to convert absorbed iron or zinc into dietary intakes, and these are summarised in this review. The European Food Safety Authority (EFSA) derived zinc requirements from a trivariate saturation response model describing the relationship between zinc absorption and dietary zinc and phytate. The average requirement for men and women was determined as the intercept of the total absorbed zinc needed to meet physiological requirements, calculated according to body weight, with phytate intake levels of 300, 600, 900 and 1200 mg/d, which are representative of mean/median intakes observed in European populations. For iron, the method employed by EFSA was to use whole body iron losses, determined from radioisotope dilution studies, to calculate the quantity of absorbed iron required to maintain null balance. Absorption from the diet was estimated from a probability model based on measures of iron intake and status and physiological requirements for absorbed iron. Average dietary requirements were derived for men and pre- and post-menopausal women. Taking into consideration the complexity of deriving DRV for iron and zinc, mainly due to the limited knowledge on dietary bioavailability, it appears that EFSA has made maximum use of the most relevant up-to-date data to develop novel and transparent DRV for these nutrients.
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Affiliation(s)
- Susan J Fairweather-Tait
- Norwich Medical School,Bob Champion Research and Educational Building,University of East Anglia,James Watson Road,Norwich NR4 7UQ,UK
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Pérez-Escamilla R. The Mexican Dietary and Physical Activity Guidelines: Moving Public Nutrition Forward in a Globalized World. J Nutr 2016; 146:1924S-7S. [PMID: 27511930 DOI: 10.3945/jn.115.218784] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 12/28/2015] [Indexed: 11/14/2022] Open
Abstract
The objective of this article is to explain the process of the development of and to assess the Mexican food-based dietary and physical activity guidelines (FBDGs). The FBDGs were developed by an intersectoral and interdisciplinary committee of 11 national experts with input from 11 external advisors. The sectors represented were research and academic institutions, the Ministry of Health, and a nongovernmental organization. The evidence-based process included the following: literature reviews of local, national, and international evidence; review of dietary patterns of the Mexican population; key national and international recommendations; and review of FBDGs and visual icons from other countries. The guidelines' report follows the life-course socioecological model rooted in a deep understanding of the epidemiology and underlying causes of malnutrition in Mexico. The guidelines are summarized in 10 pretested main recommendations that include, and go beyond, simply promoting the consumption of a healthy and varied diet that includes fresh fruits, vegetables, legumes, and whole grains and staying within caloric needs and staying active. The guidelines strongly emphasize healthy cooking habits, enjoyable meals with family and friends, drinking water, and avoiding the consumption of sweetened beverages, grain-based desserts, and highly processed foods. Detailed guidelines specific to different groups (on the basis of age and physiologic status) are also included. An innovative aspect of the Mexican FBDGs is the inclusion of dietary guidance of children <2 y of age. Future editions of these guidelines should consider removing their emphasis on dietary cholesterol and total dietary fat and placing more attention on the substitution of saturated and trans fats with healthy oils. The process of national agenda setting, policy articulation, and implementation of the Mexican FBDGs in the context of addressing the national obesity epidemic deserves to be initiated and formally assessed through the lens of evidence-based, public nutrition complex adaptive systems.
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Timotijevic L, Brown KA, Lähteenmäki L, de Wit L, Sonne AM, Ruprich J, Rehůřková I, Jeruszka-Bielak M, Sicinska E, Brito García N, Guzzon A, Jensen BB, Shepherd R, Barnett J, Raats MM. EURRECA-A framework for considering evidence in public health nutrition policy development. Crit Rev Food Sci Nutr 2014; 53:1124-34. [PMID: 23952092 DOI: 10.1080/10408398.2012.747485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A key step toward developing appropriate evidence-based public health nutrition policies is determining exactly how that evidence should be collected and assessed. Despite this the extent to which different evidence bases influence policy selection is rarely explored. This article presents an epistemological framework which offers a range of considerations affecting this process generally and with particular implications for both micronutrient requirements and the role of behavior in the policy-making process. Qualitative case study data covering 6 European countries/regions (Czech Republic, Italy, the Netherlands, Nordic countries, Poland, and Spain), and three micronutrients (folate, iodine, and vitamin D), have been presented to illustrate the relevance of the Framework.
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Affiliation(s)
- Lada Timotijevic
- Food Consumer Behaviour and Health Research Centre, Department of Psychology, University of Surrey, Guildford, Surrey, United Kingdom.
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Dhonukshe-Rutten RAM, Bouwman J, Brown KA, Cavelaars AEJM, Collings R, Grammatikaki E, de Groot LCPGM, Gurinovic M, Harvey LJ, Hermoso M, Hurst R, Kremer B, Ngo J, Novakovic R, Raats MM, Rollin F, Serra-Majem L, Souverein OW, Timotijevic L, Van't Veer P. EURRECA-Evidence-based methodology for deriving micronutrient recommendations. Crit Rev Food Sci Nutr 2014; 53:999-1040. [PMID: 23952085 DOI: 10.1080/10408398.2012.749209] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence explored the process of setting micronutrient recommendations to address the variance in recommendations across Europe. Work centered upon the transparent assessment of nutritional requirements via a series of systematic literature reviews and meta-analyses. In addition, the necessity of assessing nutritional requirements and the policy context of setting micronutrient recommendations was investigated. Findings have been presented in a framework that covers nine activities clustered into four stages: stage one "Defining the problem" describes Activities 1 and 2: "Identifying the nutrition-related health problem" and "Defining the process"; stage two "Monitoring and evaluating" describes Activities 3 and 7: "Establishing appropriate methods," and "Nutrient intake and status of population groups"; stage three "Deriving dietary reference values" describes Activities 4, 5, and 6: "Collating sources of evidence," "Appraisal of the evidence," and "Integrating the evidence"; stage four "Using dietary reference values in policy making" describes Activities 8 and 9: "Identifying policy options," and "Evaluating policy implementation." These activities provide guidance on how to resolve various issues when deriving micronutrient requirements and address the methodological and policy decisions, which may explain the current variation in recommendations across Europe. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional text, tables, and figures.].
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Van 't Veer P, Grammatikaki E, Matthys C, Raats MM, Contor L. EURRECA-Framework for Aligning Micronutrient Recommendations. Crit Rev Food Sci Nutr 2014; 53:988-98. [PMID: 23952084 DOI: 10.1080/10408398.2012.742857] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There is currently no standard approach for deriving micronutrient recommendations, and large variations exist across Europe, causing confusion among consumers, food producers, and policy makers. More aligned information could influence dietary behaviors and potentially lead to a healthier population. Funded by the European Commission, EURRECA (EURopean micronutrient RECommendations Aligned) has developed methods and applications to guide Nutrient Recommendation Setting Bodies through the process of setting micronutrient reference values. The EURRECA approach is crystallized into its framework that outlines a standard process for deriving and using dietary reference values for micronutrients in a transparent, systematic, and scientific way. The 9 activities of the framework can be clustered into four stages (i) defining the problem, (ii) monitoring and evaluating, (iii) deriving dietary reference values, and (iv) using dietary reference values in policy making. The EURRECA framework should not be interpreted as a prescriptive description of a linear process, but as a structured guide for checking that all issues essential for deriving requirements have at least been considered.
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Affiliation(s)
- Pieter Van 't Veer
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, The Netherlands
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Castro-Quezada I, Román-Viñas B, Serra-Majem L. The Mediterranean diet and nutritional adequacy: a review. Nutrients 2014; 6:231-48. [PMID: 24394536 PMCID: PMC3916858 DOI: 10.3390/nu6010231] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/16/2013] [Accepted: 12/27/2013] [Indexed: 02/07/2023] Open
Abstract
The Mediterranean dietary pattern, through a healthy profile of fat intake, low proportion of carbohydrate, low glycemic index, high content of dietary fiber, antioxidant compounds, and anti-inflammatory effects, reduces the risk of certain pathologies, such as cancer or Cardiovascular Disease (CVD). Nutritional adequacy is the comparison between the nutrient requirement and the intake of a certain individual or population. In population groups, the prevalence of nutrient inadequacy can be assessed by the probability approach or using the Estimated Average Requirement (EAR) cut-point method. However, dietary patterns can also be used as they have moderate to good validity to assess adequate intakes of some nutrients. The objective of this study was to review the available evidence on the Nutritional Adequacy of the Mediterranean Diet. The inclusion of foods typical of the Mediterranean diet and greater adherence to this healthy pattern was related to a better nutrient profile, both in children and adults, with a lower prevalence of individuals showing inadequate intakes of micronutrients. Therefore, the Mediterranean diet could be used in public health nutrition policies in order to prevent micronutrient deficiencies in the most vulnerable population groups.
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Affiliation(s)
- Itandehui Castro-Quezada
- Department of Clinical Sciences, Health Sciences Faculty, University of Las Palmas de Gran Canaria, Luis Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Blanca Román-Viñas
- Department of Clinical Sciences, Health Sciences Faculty, University of Las Palmas de Gran Canaria, Luis Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain.
| | - Lluís Serra-Majem
- Department of Clinical Sciences, Health Sciences Faculty, University of Las Palmas de Gran Canaria, Luis Pasteur s/n, Las Palmas de Gran Canaria 35016, Spain.
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Stamm RA, Houghton LA. Nutrient intake values for folate during pregnancy and lactation vary widely around the world. Nutrients 2013; 5:3920-47. [PMID: 24084052 PMCID: PMC3820052 DOI: 10.3390/nu5103920] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/18/2022] Open
Abstract
Folate is a B-vitamin with particular importance during reproduction due to its role in the synthesis and maintenance of DNA. Folate is well known for its role in preventing neural tube defects (NTDs) during the periconceptional period. There is also an increased need for folate throughout pregnancy to support optimal growth and development of the fetus and blood volume expansion and tissue growth of the mother. During lactation, women are at risk of folate deficiency due to increased demands to accommodate milk folate levels. Nutrient Intake Values (NIVs) for folate have been calculated to take into account additional needs during pregnancy and lactation. However, these values vary widely between countries. For example, the folate requirement that is set to meet the needs of almost all healthy women during pregnancy varies from 300 µg/day in the United Kingdom to 750 µg/day in Mexico. Currently, there is no accepted standardized terminology or framework for establishing NIVs. This article reviews country-specific NIVs for folate during pregnancy and lactation and the basis for setting these reference values.
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Affiliation(s)
- Rosemary A Stamm
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand.
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Annex 3: Glossary of Terms. Crit Rev Food Sci Nutr 2013. [DOI: 10.1080/10408398.2013.768489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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GIBSON RS. Harmonisation of micronutrient-based dietary standards globally: Challenges and future developments. Nutr Diet 2012. [DOI: 10.1111/j.1747-0080.2012.01614.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Freeland-Graves JH, Lee JJ. Global multiplicity of dietary standards for trace elements. J Trace Elem Med Biol 2012; 26:61-5. [PMID: 22673822 DOI: 10.1016/j.jtemb.2012.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 04/24/2012] [Indexed: 10/28/2022]
Abstract
Consistent guidelines across the world for dietary standards of trace elements remain elusive. Harmonization of dietary standards has been suggested by international agencies to facilitate consistency in food and nutrition policies and international trade. Yet significant barriers exist to standardize recommendations on a global basis, such as vast differences in geography, food availability and transport; cultural, social and economic constraints, and biological diversity. Simple commonality is precluded further by the variety of terminologies among countries and regions related to diet. Certain unions have created numerous nutritional descriptive categories for standards, while other large countries are limited to only a few. This paper will explore the global multiplicity of dietary standards and efforts for harmonization.
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Fairweather-Tait SJ. Contribution made by biomarkers of status to an FP6 Network of Excellence, EURopean micronutrient RECommendations Aligned (EURRECA). Am J Clin Nutr 2011; 94:651S-4S. [PMID: 21653802 PMCID: PMC3142732 DOI: 10.3945/ajcn.110.005736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Dietary reference values for micronutrients vary considerably among countries, and harmonization is needed to facilitate nutrition policy and public health strategies at the European and global levels. The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence is developing generic instruments for systematically deriving and updating micronutrient reference values and dietary recommendations. These include best practice guidelines, interlinked web pages, online databases, and decision trees. Journal supplements have been published on micronutrient intakes and status, and an ongoing activity of EURRECA is the completion of systematic reviews on associations between intakes, status, and various health outcomes for priority micronutrients (ie, iron, zinc, folate, vitamin B-12, and iodine), which were selected by using a triage technique. Future activities include meta-analyses to identify dose-response relations and the variability, factorial estimates of requirements, bioavailability from whole diets, effects of genotype, and modeling techniques for addressing dietary recommendations for combinations of nutrients with common health endpoints.
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Fairweather-Tait SJ, Bao Y, Broadley MR, Collings R, Ford D, Hesketh JE, Hurst R. Selenium in human health and disease. Antioxid Redox Signal 2011; 14:1337-83. [PMID: 20812787 DOI: 10.1089/ars.2010.3275] [Citation(s) in RCA: 777] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This review covers current knowledge of selenium in the environment, dietary intakes, metabolism and status, functions in the body, thyroid hormone metabolism, antioxidant defense systems and oxidative metabolism, and the immune system. Selenium toxicity and links between deficiency and Keshan disease and Kashin-Beck disease are described. The relationships between selenium intake/status and various health outcomes, in particular gastrointestinal and prostate cancer, cardiovascular disease, diabetes, and male fertility, are reviewed, and recent developments in genetics of selenoproteins are outlined. The rationale behind current dietary reference intakes of selenium is explained, and examples of differences between countries and/or expert bodies are given. Throughout the review, gaps in knowledge and research requirements are identified. More research is needed to improve our understanding of selenium metabolism and requirements for optimal health. Functions of the majority of the selenoproteins await characterization, the mechanism of absorption has yet to be identified, measures of status need to be developed, and effects of genotype on metabolism require further investigation. The relationships between selenium intake/status and health, or risk of disease, are complex but require elucidation to inform clinical practice, to refine dietary recommendations, and to develop effective public health policies.
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Affiliation(s)
- Susan J Fairweather-Tait
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk, United Kingdom.
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European micronutrient recommendations aligned: a general framework developed by EURRECA. Eur J Clin Nutr 2010; 64 Suppl 2:S2-10. [PMID: 20517317 DOI: 10.1038/ejcn.2010.55] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In Europe, micronutrient recommendations have been established by (inter)national committees of experts and are used by public health-policy decision makers to monitor and assess the adequacy of the diets of population groups. Current micronutrient recommendations are, however, heterogeneous, whereas the scientific basis for this is not obvious. Alignment of setting micronutrient recommendations is necessary to improve the transparency of the process, the objectivity and reliability of recommendations that are derived by diverse regional and (inter)national bodies. OBJECTIVE This call for alignment of micronutrient recommendations is a direct result of the current sociopolitical climate in Europe and uncovers the need for an institutional architecture. There is a need for evidence-based policy making, transparent decision making, stakeholder involvement and alignment of policies across Europe. RESULTS In this paper, we propose a General Framework that describes the process leading from assessing nutritional requirements to policy applications, based on evidence from science, stakeholder interests and the sociopolitical context. The framework envisions the derivation of nutrient recommendations as scientific methodology, embedded in a policy-making process that also includes consumer issues, and acknowledges the influences of the wider sociopolitical context by distinguishing the principal components of the framework: (a) defining the nutrient requirements for health, (b) setting nutrient recommendations, (c) policy options and (d) policy applications. CONCLUSION 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.
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Iglesia I, Doets EL, Bel‐Serrat S, Román B, Hermoso M, Peña Quintana L, García‐Luzardo MDR, Santana‐Salguero B, García‐Santos Y, Vucic V, Frost Andersen L, Pérez‐Rodrigo C, Aranceta J, Cavelaars A, Decsi T, Serra‐Majem L, Gurinovic M, Cetin I, Koletzko B, Moreno LA. Physiological and public health basis for assessing micronutrient requirements in children and adolescents. The EURRECA network. MATERNAL & CHILD NUTRITION 2010; 6 Suppl 2:84-99. [PMID: 22296252 PMCID: PMC6860598 DOI: 10.1111/j.1740-8709.2010.00273.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This paper provides an overview of the current knowledge relating to the nutritional requirements and corresponding recommended nutrient intake values of children and adolescents for micronutrients and specificities related to these requirements in the course of childhood and adolescence in Europe. Aspects that can influence micronutrient requirements, such as physiological requirements and bioavailability of the nutrients in the organism, are discussed. The methodology used to obtain the data and also the main knowledge gaps regarding these concepts are emphasized. Methodological critical points in achieving the data and physiological aspects of children and adolescents are important in order to standardize the reference values for micronutrients among Europe for these stages of life.
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Affiliation(s)
- Iris Iglesia
- Growth, Exercise, Nutrition and Development Research Group (GENUD), Escuela Universitaria de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
| | - Esmée L. Doets
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, the Netherlands
| | - Silvia Bel‐Serrat
- Growth, Exercise, Nutrition and Development Research Group (GENUD), Escuela Universitaria de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
| | - Blanca Román
- Community Nutrition Research Foundation, Barcelona Science Park, University of Barcelona, Barcelona, Spain
| | - Maria Hermoso
- Division of Metabolic Diseases and Nutritional Medicine, Dr von Hauner Children's Hospital, Ludwig‐Maximilians‐University of Munich, Munich, Germany
| | - Luis Peña Quintana
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Complejo Hospitalario Universitario Insular Materno‐Infantil, Las Palmas, Spain
- Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Spain
| | - María del Rosario García‐Luzardo
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Complejo Hospitalario Universitario Insular Materno‐Infantil, Las Palmas, Spain
| | - Beatriz Santana‐Salguero
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Complejo Hospitalario Universitario Insular Materno‐Infantil, Las Palmas, Spain
| | - Yurena García‐Santos
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Complejo Hospitalario Universitario Insular Materno‐Infantil, Las Palmas, Spain
| | - Vesna Vucic
- Institute for Medical Research, Department for Nutrition and Metabolism, University of Belgrade, Belgrade, Serbia
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University, of Oslo, Oslo, Norway
| | - Carmen Pérez‐Rodrigo
- Community Nutrition Unit, Public Health Local Subarea, Bilbao Council, Bilbao City Hall, Spain
| | - Javier Aranceta
- Community Nutrition Unit, Public Health Local Subarea, Bilbao Council, Bilbao City Hall, Spain
| | - Adrienne Cavelaars
- Department of Nutrition, Institute of Basic Medical Sciences, University, of Oslo, Oslo, Norway
| | | | - Lluis Serra‐Majem
- Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Spain
| | - Mirjana Gurinovic
- Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Spain
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Department of Clinical Sciences, Hospital ‘L. Sacco’, and Center for Fetal Research Giorgio Pardi, University of Milan, Milano, Italy
| | - Berthold Koletzko
- Division of Metabolic Diseases and Nutritional Medicine, Dr von Hauner Children's Hospital, Ludwig‐Maximilians‐University of Munich, Munich, Germany
| | - Luis Alberto Moreno
- Growth, Exercise, Nutrition and Development Research Group (GENUD), Escuela Universitaria de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain
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Hermoso M, Tabacchi G, Iglesia-Altaba I, Bel-Serrat S, Moreno-Aznar LA, García-Santos Y, García-Luzardo MDR, Santana-Salguero B, Peña-Quintana L, Serra-Majem L, Moran VH, Dykes F, Decsi T, Benetou V, Plada M, Trichopoulou A, Raats MM, Doets EL, Berti C, Cetin I, Koletzko B. The nutritional requirements of infants. Towards EU alignment of reference values: the EURRECA network. MATERNAL & CHILD NUTRITION 2010; 6 Suppl 2:55-83. [PMID: 22296251 PMCID: PMC6860534 DOI: 10.1111/j.1740-8709.2010.00262.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This paper presents a review of the current knowledge regarding the macro- and micronutrient requirements of infants and discusses issues related to these requirements during the first year of life. The paper also reviews the current reference values used in European countries and the methodological approaches used to derive them by a sample of seven European and international authoritative committees from which background scientific reports are available. Throughout the paper, the main issues contributing to disparities in micronutrient reference values for infants are highlighted. The identification of these issues in relation to the specific physiological aspects of infants is important for informing future initiatives aimed at providing standardized approaches to overcome variability of micronutrient reference values across Europe for this age group.
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Affiliation(s)
- Maria Hermoso
- Division of Metabolic Diseases and Nutritional Medicine, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
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The process of setting micronutrient recommendations: a cross-European comparison of nutrition-related scientific advisory bodies. Public Health Nutr 2010; 14:716-28. [DOI: 10.1017/s1368980010002363] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo examine the workings of the nutrition-related scientific advisory bodies in Europe, paying particular attention to the internal and external contexts within which they operate.DesignDesk research based on two data collection strategies: a questionnaire completed by key informants in the field of micronutrient recommendations and a case study that focused on mandatory folic acid (FA) fortification.SettingQuestionnaire-based data were collected across thirty-five European countries. The FA fortification case study was conducted in the UK, Norway, Denmark, Germany, Spain, Czech Republic and Hungary.ResultsVaried bodies are responsible for setting micronutrient recommendations, each with different statutory and legal models of operation. Transparency is highest where there are standing scientific advisory committees (SAC). Where the standing SAC is created, the range of expertise and the terms of reference for the SAC are determined by the government. Where there is no dedicated SAC, the impetus for the development of micronutrient recommendations and the associated policies comes from interested specialists in the area. This is typically linked with anad hocselection of a problem area to consider, lack of openness and transparency in the decisions and over-reliance on international recommendations.ConclusionsEven when there is consensus about the science behind micronutrient recommendations, there is a range of other influences that will affect decisions about the policy approaches to nutrition-related public health. This indicates the need to document the evidence that is drawn upon in the decisions about nutrition policy related to micronutrient intake.
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Developing micronutrient reference values: prioritization of tool development by the EURRECA Network of Excellence. Eur J Clin Nutr 2010; 64 Suppl 2:S11-8. [DOI: 10.1038/ejcn.2010.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bor MV, von Castel-Roberts KM, Kauwell GP, Stabler SP, Allen RH, Maneval DR, Bailey LB, Nexo E. Daily intake of 4 to 7 microg dietary vitamin B-12 is associated with steady concentrations of vitamin B-12-related biomarkers in a healthy young population. Am J Clin Nutr 2010; 91:571-7. [PMID: 20071646 DOI: 10.3945/ajcn.2009.28082] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies have questioned whether the current Recommended Dietary Allowance (RDA) of 2.4 microg vitamin B-12/d is adequate. OBJECTIVE We examined the association between dietary vitamin B-12 intake and biomarkers of vitamin B-12 status. DESIGN Dietary vitamin B-12 intake was estimated, and biomarkers of vitamin B-12 status were measured, in healthy men and women (n = 299; age range: 18-50 y) who were recruited from a Florida community. The National Cancer Institute Diet History Questionnaire was used. Plasma cobalamin, total transcobalamin, holo-transcobalamin, methylmalonic acid (MMA), total homocysteine (tHcy), and autoantibodies against intrinsic factor (IF) and Helicobacter pylori were analyzed in blood samples. RESULTS Antibodies to H. pylori were detected in 12% of subjects (35/299), and negative results for IF antibodies were obtained for all subjects. The intake of vitamin B-12 correlated significantly with cobalamin, holo-transcobalamin, MMA, and tHcy. Subjects were divided into quintiles on the basis of their dietary vitamin B-12 intake (range: 0.42-22.7 microg/d), and biomarkers of vitamin B-12 status were plotted against estimated dietary vitamin B-12 intake. All biomarkers appeared to level off at a daily dietary vitamin B-12 intake between 4.2 and 7.0 microg. CONCLUSION In persons with normal absorption, our data indicate that an intake of 4-7 microg vitamin B-12/d is associated with an adequate vitamin B-12 status, which suggests that the current RDA of 2.4 microg vitamin B-12/d might be inadequate for optimal biomarker status even in a healthy population between 18 and 50 y of age.
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Affiliation(s)
- Mustafa Vakur Bor
- Department of Clinical Biochemistry, AS Aarhus University Hospital, Aarhus, Denmark.
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Pijls L, Ashwell M, Lambert J. EURRECA – A Network of Excellence to align European micronutrient recommendations. Food Chem 2009. [DOI: 10.1016/j.foodchem.2008.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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How we will produce the evidence-based EURRECA toolkit to support nutrition and food policy. Eur J Nutr 2008; 47 Suppl 1:2-16. [DOI: 10.1007/s00394-008-1002-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The process of applying nutrient intake values (NIVs) for dietary assessment, planning, and implementing programs is discussed in this paper. In addition to assessing, monitoring, and evaluating nutritional situations, applications include planning food policies, strategies, and programs for promotion of optimal nutrition and preventing and treating malnutrition (both over- and undernutrition). Other applications include nutrition education, food and nutrient legislation, marketing and labeling, research, product development, food procurement and trade (import and export), food aid, and therapeutic (clinical) nutrition. Specific examples of how NIVs are used to develop food labels, fortification policies, and food-based dietary guidelines are described. Applications in both developed and developing countries are also described. In summary, NIVs are the scientific backbone of all aspects of nutrition policy in countries and regions worldwide.
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Affiliation(s)
- Hester H Vorster
- Faculty of Health Sciences, NWU (Potchefstroom Campus), Potchefstroom 2520, South Africa.
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