Harmonized nutrient variety -
For example, ARs will differ if different physiological determinants were used, the data were limited, the bioavailability or absorption factors differed, or the life-stage groupings varied. To illustrate, dietary phytate is a major determinant of zinc absorption. Iron bioavailability, and thus absorption, is determined by its form.
Heme iron from animal sources has a higher bioavailability than non-heme iron from vegetable and grain sources. Both dietary phytate and non-heme iron are more prevalent in the food supplies among low- and middle-income countries, thus contributing to a higher prevalence of deficiency and increased physiologic requirement in those populations.
Additionally, iron stores, a biomarker of iron status, can be modified by chronic disease, infection, or other nutrient deficiencies, further contributing to increased physiologic requirements for this nutrient NASEM, b.
The UL is the highest average daily nutrient intake level likely to pose no risk of adverse health effects for nearly all people in a particular group. The need to set a UL grew out. of two major trends: increased fortification of foods with nutrients and the more prevalent use of dietary supplements in larger doses.
A challenge in setting a UL is the paucity of data indicating adverse health effects from chronic intakes or high intake levels of nutrients with potential toxicity. Thus, experimental animal and observational data are useful for setting this standard.
Another challenge is the use of competing risk-benefit analyses for chronic disease outcomes as opposed to toxicity-related outcomes. The level of risk from chronic disease differs among possible adverse health outcomes, thus introducing another level of uncertainty that must be considered in the derivation of a UL.
Developing the key nutrient reference values i. The process for deriving harmonized standards is based on six core principles:. To date, several groups have incorporated some or all of these principles when setting their NRVs.
They include the U. The National Academies publication Harmonization of Approaches to Nutrient Reference Values provides case studies depicting how to use this paradigm for establishing ARs and ULs for zinc, iron, and folate NASEM, b. The case studies demonstrate how to use the proposed framework as an approach for harmonizing the methods for deriving NRVs on a global scale.
Proposed Harmonized Nutrient Reference Values for Populations have been published; ideally these would continue to be revised and be supported by an authoritative international body for global application Allen et al. 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.
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Harmonizing the Process for Establishing Nutrient Reference Values: A Tool Kit Chapter: Part 3: Developing a Harmonized Process for Deriving Nutrient Reference Values. Get This Book. Visit NAP. Looking for other ways to read this? No thanks. Suggested Citation: "Part 3: Developing a Harmonized Process for Deriving Nutrient Reference Values.
Harmonizing the Process for Establishing Nutrient Reference Values: A Tool Kit. Washington, DC: The National Academies Press. doi: Part 3: Developing a Harmonized Process for Deriving Nutrient Reference Values Currently, countries and organizations use varying terminology to express nutrient reference values NRVs.
Four of these NRVs are considered to be the core reference values—the average requirement AR , the recommended nutrient intake RNI , the adequate intake AI , and the upper level of intake UL : AR.
The amount of a nutrient estimated to meet the nutrient requirement of 50 percent of the healthy individuals in a population. RNI derived from the AR. The average daily intake for a nutrient that is sufficient to meet the requirements of percent of the population.
The recommended average intake of a nutrient based on observed or experimentally determined estimates for an apparently healthy population. This value is derived when evidence for an AR is insufficient.
The highest average daily nutrient intake that is likely to pose no risk of adverse effects to most individuals in a population. It does not include acute or episodic high intakes that might be consumed in a supplement, for example.
Page 14 Share Cite. The framework, shown in Figure 2 , has four core elements: Choose the appropriate tools and data resources. Collect data from the tools and resources. Identify the best approach for the nutrient under consideration. Derive the two key reference values—AR and UL.
FIGURE 2 Framework for deriving key nutrient reference values. Systematic reviews and databases inform how local and regional factors are considered.
Page 15 Share Cite. Critical Characteristics In addition, the following characteristics are critical to the NRV review process and help to support harmonization of the approaches to setting NRVs across multiple countries.
NRVs must be: Regularly updated. Given the rapid pace of the generation of knowledge and data on which NRVs are based, it is important to maintain the currency of information on nutrient outcomes as well as the nutritional profile of populations, particularly as supplement use increases and fortification programs are established.
Confidence in the systematic reviews that lead to updated or new NRVs is necessary to ensure their use by policy makers as well as researchers. Such credibility requires the establishment of a transparent process that covers how members of the review panels are selected and the training and expertise of each; public availability of all material reviewed by the committee during its deliberations; and written protocols for systematic reviews, quality assessment of each study, assumptions made, and evidence synthesis leading up to setting the NRVs.
Consistent methods need to be established and applied across nutrients, for various values e. A uniform approach for conducting systematic reviews and establishing values for nutrients in cases where evidence is limited also is needed.
Given the changing epidemiologic and nutritional status across populations, values need to be relevant to contexts where chronic disease is rising, in addition to being relevant to the prevention of deficiency. At each stage in the process, all considerations or adjustments that influence the potential NRV must be documented, as must the methodologies used and the assumptions behind them.
Based on a determination of the strength of the evidence. Limitations in the data and methods must be assessed and documented and uncertainties taken into account. Page 16 Share Cite. Complete and efficient. Given the cost, time, and expertise required to undertake the development or revision of existing reference values, even in high-income countries, low- and middle-income countries could consider using existing NRVs developed by another international partner if they are deemed adequate.
Using the Framework to Derive Nutrient Reference Values The first major step in the framework is choosing the appropriate tools and resources for reviewing and assessing the evidence. Collect Tools and Resources Systematic Reviews Systematic reviews are a rigorous and transparent method of collecting and synthesizing relevant published literature.
Page 17 Share Cite. Assessing uncertainty in the evidence. Evaluating the risk of bias is an essential step in systematic reviews and requires an assessment of the internal and external validity of each study included in the review.
Bias occurs when the results of the review are distorted by systematic flaws or limitations in the design or conduct of a study. They can be introduced at various points in a study and are important to identify because they can affect the conclusions and the interpretation of results.
A number of tools have been developed in recent years to evaluate different types of risk of bias. Page 18 Share Cite. Assessing uncertainty in the review process. A shortcoming common to many systematic reviews is that they pool studies that use different types of evidence, such as various study designs, different populations, or the use of animal and human data.
Because this heterogeneity leads to uncertainty, pooling studies should be conducted only when they meet meta-analysis criteria.
Evidence mapping—a way to systematically identify, organize, and summarize available studies and identify gaps and research needs—can help to reduce this bias. Report a Problem. Export RIS. Export to Excel. How to get it. Please sign into your library account to place requests.
University of Idaho Available in institution. Back to institutions. Get it from other locations. Sign in. Resource sharing is only allowed under specific terms and conditions. Item Details. Harmonization of approaches to nutrient reference values : applications to young children and women of reproductive age.
National Academies of Sciences, Engineering, and Medicine U. Washington, DC : The National Academies Press.
Food and Nutrition Board, issuing body. Health and Medicine Division, issuing body. Creation Date. However, with the increasing globalization of information and the identification of a variety of factors specific to different population subgroups e.
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"--Publisher's description. Series statement: Consensus study report.
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In the current context of major differences between nutrition legislation in different jurisdictions, I propose the use of an estimation of similitudes k is the ratio of similitude and gap indices g is the absolute inconsistency value as objective harmonization indicators.
These are used to measure the similarities and differences among current global standards for nutrients, energy daily reference value DRV , and reference daily intake RDI. where the k is ratio of similitude, L STAN 1 is the absolute value of DRV, and L STAN 2 represents the DRV for a second standard, with an L STAN 1 value less than or equal to L STAN 2.
This equation measures the degree to which two existing standards from two different jurisdictions are harmonized.
where g is the absolute inconsistency value and L STAN 1 and L STAN 2 represent the DRV required within standards 1 and 2, respectively. Depending on the current degree of harmonization dependent on the k value , specific recommendations are proposed Table 2 10 to progressively improve the current harmonization level over a 4-year cycle agreed upon by specific jurisdictions, if the declaration of intent to follow the harmonization pathway is signed and adopted.
Also, the new paradigm in the harmonization of global nutrition legislation needs to respond to the huge expectation regarding equity in food quality assessment and international trade. Consumers have the difficult task of choosing suitable nutritional foods without a simple, comprehensive tool that provides consistent nutritional information.
A Demand for Quality and Equity in Food. An honest scientific assessment, using global harmonized nutritional quality indicators and global reference food standards, needs to be developed to solve this issue. In international food trade, coherent food standards are crucial for comparing and assessing food nutritional quality using a widely adopted nutritional standard of reference for each food and beverage group.
Nutrition labeling needs to serve the final consumer in terms of their daily food selection, enabling healthier choices for their particular age, gender, health status, preferences, eating habits, etc.
In particular, front-of-pack FOP labeling must support the global food industry by providing clear information on food formulations using suitable food production systems. Table 2: Degree of Harmonization and Required Actions for Improving the Current Level of Nutrition Several issues must be considered prior to implementing a mandate for harmonized FOP nutrition labeling:.
EFSA Aims to Walk a Politically Sensitive Line. The Global Harmonization Initiative Nutrition Working Group is working on harmonized FOP labeling as a flag project and will soon publish an official opinion on this important topic to be solved at the EU level.
Advances in Nutrition Yaktine, A. Shlisky, J. Annals of the New York Academy of Sciences in Press. Bourassa, M. Contact us to get involved! This site uses cookies to provide you with a personalized browsing experience. Please read the Privacy Notice for more information on how we handle information collected from users and how you can control the use of such information.
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Accept Deny View preferences Save preferences View preferences. Meanwhile, the H-ARs and H-ULs suggested in this review can be used to assess intakes of populations for many applications in global and regional contexts.
Keywords: harmonized average requirement; harmonized upper level; nutrient intake recommendations; nutrient reference value; nutrient requirement. Published by Oxford University Press on behalf of the American Society for Nutrition Abstract Two core nutrient intake reference values NRVs are required for assessing the adequacy and safety of nutrient intakes for population groups: the average requirement AR and the tolerable upper level of intake UL.
Not Herbal tea for dental health MyNAP member yet? Harmonized nutrient variety for a free nutrieht to start saving and receiving Haemonized member Haronized perks. Gariety elaborated in the earlier chapters in this report, the Visceral fat and nutrient metabolism for a Cardiovascular health to harmonize the Cardiovascular health for establishing nutrient reference values NRVs began in the s, with discussions among experts from the United States, Canada, and the United Kingdom. This led to convening an international stakeholder group to lay out the components of a universally applicable organizing framework King and Garza, In the interim, new tools have been developed that were not available or used previously. These include systematic reviews, larger and more accessible databases, information on factors affecting culture- and context-specific food choices and dietary patterns, new modeling techniques e.
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