5.6: European Dietary Reference Values (8a.6)

In 1993, the Scientific Committee for Food of the European Community (SCEC, 1993) proposed three reference values for each nutrient (Box 8a.6). sub­sequently, over a seven-year period, the European Food Safety Authority (EFSA) has generated separate publications on the NRVs for water, fats, carbohydrates, dietary fiber, protein, energy and 14 vitamins and 13 minerals, as well as a summary report (2017).

Box 8a.6 SCEC Dietary Reference Values

• Average Requirement
• Pop­ula­tion Reference Intake
• Lower Threshold Intake

8a.6.1 European Average Requirements (ARs) for nutrients

The Average Requirement defined by EFSA is the mean require­ment of a specific gender and life-stage group. The group was assumed to have a normal, symmetrical distribution, with the exception of the iron needs of menstru­ating women (2017). The EFSA ARs for vitamins, minerals, and trace elements for adults only shown in Table 8a.6. For the ARs for all life-stage groups for minerals and vitamins, see Appendix 8a.5 and Appendix 8a.6 respectively.

8a.6.2 European Pop­ula­tion Reference Intake (PRI = RI)

EFSA (2017) defined “Pop­ula­tion Reference Intakes” as the intake level ade­quate for virtually all people in a pop­ula­tion group. It corresponds conceptually with the RI₉₈, and hence represents the AR + 2SD. The EFSA PRIs for vitamins, minerals, and trace elements for adults only are given in Table 8a.6 For the PRIs for all life-stage groups for minerals and vitamins, see Appendix 8a.7 and Appendix 8a.8 respectively.

For some life-stage groups where no data were available, interpolation or extrapolation was used by EFSA to set ARs and PRIs. The reference heights and body weights used by EFSA for children aged 0–2y are from the WHO Child Growth Standard (WHO, 2006), whereas for older children 2–18ythey use data from European children (van Buuren et al., 2012). Details of the reference body weights for children and adults used for scaling are given in (EFSA, 2017). Details of the criteria used to set the DRVs for infants (7–11mos, children (1–17y), adults, and pregnant and lactating women together with the type of studies used are also presented.

8a.6.3 European Tolerable Upper Intake Level for nutrients

The Tolerable Upper Intake Level (UL) was defined by EFSA as the maximum level of total chronic daily intake of a nutrient (from all sources — food, supplements, fortificants, water) judged to be unlikely to pose a risk of adverse health effects in humans (2017). ULs for six vitamins and eight minerals were established by SCEC in 2006 which are available in a summary report (EFSA, 2018). This report also provides updated information for the UL for vitamin D for infants aged 0–6mo and 6–12mo.

8a.6.4. European Additional Levels

Table 8a.6 European Food Safety Authority Dietary Reference Values for adults. From EFSA (2017). Data for women, where different from that for men, are given in parentheses. MJ: megajoules; DFE: dietary folate equivalents. For combined intake of food folate and folic acid, DFEs can be computed as follows: µg DFE = µg food folate + (1.7 × µg folic acid); NE: niacin equivalent (1mg niacin = 1 niacin equivalent = 60mg dietary tryptophan); RE: retinol equivalent, 1µg RE = 1µg of retinol, 6µg of β-carotene and 12µg of other provitamin A carotenoids. *18–24y;** > 25y; *** AI (no AR has been set); ^ premenopausal; ^^ postmenopausal; Zn AR and PRI associated with 300, 600, 900, 1200mg phytate/d

Nutrient	Average Requirement (AR)	Population Reference Intake (PRI)
Protein (g)	0.66 g/kg/BW/d	0.83 g/k/BW/d
Vitamins
Vitamin A (µg/d)	570 (490)	750 (650)
Thiamin (mg/MJ)	0.072	0.1
Riboflavin (mg/d)	1.3	1.6
Niacin (mg NE/MJ)	1.3	1.6
Vitamin B6 (mg/d)	1.5 (1.3)	1.7 (1.6)
Cobalamin(µg/d)	4.0***	4.0
Vitamin C (mg/d)	90 (80)	110 (95)
Folate (µg DFE/d)	250	330
Minerals
Calcium (mg/d)	860*, 750**	1000*, 950**
Phosphorus (mg/d)	550***
Potassium (mg/d)	3500***
Trace elements
Iron (mg/d)	6 (7^, 6^^)	11 (16^; 11^^)
Zinc (mg/d)	7.5;9.3;11.0;12.7 (6.2;7.6;8.9;10.2)	9.4;11.7;14.0;16.3 (7.5;9.3;11.0;12.7)
Copper (mg/d)	1.6*** (1.5***)
Selenium (ug/d)	70***
Iodine (ug/d)	150***

Lower Threshold Intake (LTI) is one of two additional levels defined by the EFSA (2017) panel. The LTI is the intake below which almost all indi­viduals in the pop­ula­tion will be unable to maintain metabolic integrity according to the criterion chosen for each nutrient. The LTI represents the mean − 2SD.

Ade­quate Intake (AI) represents a value estimated when a Pop­ula­tion Reference Intake cannot be established because an average require­ment cannot be determined. An AI is the average observed daily level of intake by a pop­ula­tion group (or groups) of appar­ently healthy people that is assumed to be ade­quate.

The EFSA (2017) report presents AI values for infants 0–6mo based on the nutrient supply from human milk. An AI is also given for those nutrients for which the data were deemed inade­quate to set an AR (i.e., fluoride, iodine, manganese, molybdenum, phosphorus, potassium, selenium, copper, magnesium, biotin, choline, cobalamin, pantothenic acid, vitamin D, vitamin K). For a detailed discussion of these reference values, refer to EFSA (2017).

8a.6.5. European Average Requirement for Energy

The average require­ments (ARs) for energy expressed as MJ/d for pop­ula­tion groups within Europe are presented for specified age groups, and by gender for selected physical activity levels (PALs), depending on age (Table 8a.7); they are of limited use for indi­viduals. ESFA also chose total energy expenditure (TEE) as the criterion on which to base the AR for energy for both adults and children. However, they determined TEE factorially from estimates of resting energy expenditure (REE), plus the energy needed for various levels of physical activity (PAL) associated with sustainable lifestyles in healthy indi­viduals. The equation is shown below:

\[\mathrm{TEE}=\mathrm{PAL} \times \mathrm{REE}\nonumber\]

where PAL is a given physical activity level, and REE is resting energy expenditure. Table 8a.7.

Table 8a.7: ARs for energy (MJ/d) for adults. Note: The ARs for energy (1MJ = 238.83kcal) are calculated by multiplying estimates of resting energy expenditure (REE) predicted from anthropometric measures (Henry, 2005) with PAL values.
PAL values of 1.4. 1.6, 1.8, and 2.0 reflect low-active (sedentary), moderately active, active, and very active lifestyles, respectively.
Data from EFSA : ARs for infants and children and adjustments for pregnancy and lactation are also presented in EFSA (2013).

Age	PAL=1.4 M F	PAL=1.6 M F	PAL=1.8 M F	PAL=2 M F
18–29y	9.8 7.9	11.2 9.0	12.6 10.1	14.0 11.2
30–39y	9.5 7.6	10.8 8.7	12.2 9.8	13.5 10.8
40–49y	9.3 7.5	10.7 8.6	12.0 9.7	13.4 10.7
50–59y	9.2 7.5	10.5 8.5	11.9 9.6	13.2 10.7
60–69y	8.4 6.8	9.6 7.8	10.9 8.8	12.1 9.7
70–79y	8.3 6.8	9.5 7.7	10.7 8.7	11.9 9.6

ESFA (2017) selected REE as a proxy for the slightly lower basal metabolic rate (BMR) because most studies estimated or measured REE. REE was estimated using the predictive equations of Henry (2005) which are derived from large datasets covering wide age groups. For adults 18–79y, the calculated REE was based on indi­vidual body heights measured in representative national surveys in 13 EU Member States, and body masses calculated from the measured heights assuming a BMI of 22kg/m².

PAL values were estimated from time-allocated lists of daily activities expressed as physical activity ratios available from the Compendium of Physical Activities compiled by Ainsworth et al.(2011) Examples of lifestyles associated with certain PALs estimated over 24h are tabulated in ESFA (2013).

To derive TEE as REE × PAL, PAL values of equal steps within the observed range of physical activity levels associated with a sustainable lifestyle were chosen for calculating AR for energy. In this way, PAL values could be allocated to lifestyles where values of 1.4, 1.6, 1.8 and 2.0, approximately reflect: low active (sedentary), moderately active, active, and very active lifestyles, were used, as shown in Table 8a.7.

No ARs for energy were calculated for adults > 80y in view of the paucity of European anthropometric data for this age group.

For infants from 0–6mos, energy require­ments (i.e., ARs) were considered to be equal to the energy supply from human milk, and no AR was given. For infants aged 7–11mos, ARs were derived from TEE estimated by regression equations using DLW data, adding energy deposited in tissues for growth from the literature. Body masses for this age group were based on the WHO Child Growth Standards (WHO, 2006).

For children 1–18y, ARs for energy were based on predicted REE using the equations of Henry (2005) and using body masses and height from the WHO Growth Standards for children up to 2y, or from harmonized European growth curves for children 3–17y (van Buuren et al., 2012). PAL values of 1.4, 1.6, 1.8, and 2.0 were also applied for children. Energy expenditure for growth was accounted for by a 1% increase in PAL values for each of the three age groups (1–3y, > 3 – < 10y, and 10–18y).

For pregnant women, additional energy require­ments were based on a mean gestational increase in body mass of 12kg, whereas for women exclusively breastfeeding during the first 6mos, the additional energy require­ment during lactation was estimated factorially: see EFSA (2013) for more details.

8a.6.6 EFSA Reference Intake Ranges for Macronutrients

Reference Intake Ranges for Macronutrients have also been set by EFSA and are available in the 2017 summary report . The Reference Intake Ranges are defined as the intake range for macro­nutrients, expressed as a percentage of the energy intake and are intended as population averages. They apply to ranges of intakes that are ade­quate for maintaining health and associated with a low risk of selected chronic diseases.

Table 8a.8 presents the macro­nutrients with a defined reference intake range expressed as the percentage of the energy intake for adults (> 18y) for total carbohydrate, total fat, linoleic acid (LA), and α‑linolenic acid (ALA). A comparison with those set by the UK and WHO, also intended as pop­ula­tion averages is presented in Table 8a.3. In contrast, the U.S and Canadian recom­men­dations, also shown in Table 8a.3, are intended for use by indi­viduals. Note for saturated fatty acids (SFAs) and trans-fatty acids (TFAs), an intake as low as possible is advised, whereas for dietary fiber and eicosa­pentanoic acid (EPA) plus docosa­hexanoic acid (DHA) , an AI is given. No reference intake ranges are given for protein, n-6 poly­un­saturated fatty acids (PUFAs) or n-3 PUFAs, unlike WHO (see Section 8a.7.6). Likewise, no recom­men­dation to restrict daily intake of cholesterol (mg/d) is stated, although an AI has been set for dietary fiber (g/d) which varies by age group. Note the data shown in Table 8a.8 can be used to assess the proportion of indi­viduals in the pop­ula­tion in a specified life-stage group with usual intakes outside the reference lower and upper limits of the range.

Table 8a.8: Reference Intake Ranges for total fat and carbohydrates and AIs for fatty acids and dietary fiber for adults ≥ 18y, and during pregnancy and lactation. From EFSA, 2017.

	Adults ≥18	Pregnancy	Lactation
Total Carbohy- drates (E%)^(a)	45–60
Dietary fiber (g/d)^(b)	25
Total Fat (E%)^(a)	20–35	20–35	20–35
SFA	ALAP	ALAP	ALAP
LA (E%)^(b)	4	4	4
ALA (E%)^(b)	0.5	0.5	0.5
EPA+DHA (mg/d)^(b)	250	250	250
DHA (mg/d)^(b)		+100–200^(c)	+100–200^(c)
TFA	ALAP	ALAP	ALAP