6: Evaluation of intakes and diets (Chapter 8b)
- Page ID
- 116792
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)This chapter addresses the assessment of nutrient intakes and the planning of nutritious diets at both the individual and population level. To assess intakes at the individual level for nutrients with an Average Requirement (AR) and Recommended Intake (RI), the likelihood of inadequacy can be assessed by using a statistical test that examines the individual's observed usual intake in combination with measures of variability of intakes and requirements. For nutrients with an Adequate Intake (AI) and Upper Intake Level (UL), statistical tests can be used to determine the level of confidence that an individual's observed usual intake is at or above the AI, or below the UL, respectively. Alternatively, published guidelines can provide a qualitative interpretation of the adequacy of an individual's usual intake of nutrients and macronutrients in relation to the Nutrient Reference Values (NRVs), and the Acceptable Macronutrient Distribution Range (expressed as a percentage of energy) (AMDR), respectively.
For assessment of intakes at the group level, the proportion with usual nutrient intakes below the AR and/or above the UL can be calculated by the probability approach or the simpler Estimated Average Requirement (EAR) cutpoint method. For nutrients with an AI that represents the mean or median intake of an apparently healthy group, when the group mean or median intake is at or above the AI, then it is likely that the prevalence of inadequate intakes for the group is low.
When planning nutritious diets for individuals, usual nutrient intakes should fall between the RI98 and the UL, or between the AI or UL. For energy and macronutrients, however, the targets for the diet are the individual's Estimated Energy Requirement (EER) and within the AMDR, respectively. For planning nutritious diets for groups, the current distribution of usual nutrient intakes should be altered to ensure a low prevalence of undesirable nutrient intakes, whereas for the appropriate energy level, the group mean energy intake must be close to the group mean EER. For the macronutrients, diets must be planned to reduce the prevalence of intakes outside the AMDR.
Dietary intake data generated from conventional dietary assessment methods have been severely criticized in the past because both random and systematic errors occur in measuring intakes of food and calculating their nutrient content (Subar et al., 2015). The data are also frequently misinterpreted. This is particularly unfortunate because the careful evaluation of food- and nutrient-intake data has important uses and applications, provided that the limitations of the methods are clearly understood.
This chapter describes the assessment of nutrient intakes and the planning of nutritious diets at both the individual and population level. Most of the approaches used are based on comparison of the usual daily intake of an individual or group with the appropriate Nutrient Reference Values (NRVs) or the Acceptable Macronutrient Distribution Ranges (AMDRs). The tables of NRVs have now been expanded in many countries and regions to include:
- An Average Requirement (AR), referred, in some countries, as an Estimated Average requirement (EAR).
- A Recommended Intake (RI98), termed a Recommended Dietary Allowance (RDA) in Canada and the U.S.
- An Adequate Intake (AI) and/or an Upper Intake Level (UL),
Each NRV has a specific use as a reference standard for diet assessment and planning; their derivation is described in Chapter 8a. The AI is used for those nutrients for which there is insufficient available information to set an AR. Development of the UL arose because of the increasing availability of fortified foods and dietary supplements worldwide, and concern about ingesting too much of a nutrient.
- 6.1: Applications of Nutrient Reference Values in diet assessment and planning (8b.1)
- This page discusses the growing adoption of multiple Nutrient Reference Values (NRVs) by countries for nutrient assessment and diet planning. Individuals often struggle with accurately assessing their own nutrient intakes, while professionals can use qualitative methods for dietary guidance. New frameworks for group assessments consider average requirements and upper intake levels to evaluate nutrient risks.
- 6.2: Using the NRVs to assess nutrient intakes of an individual (8b.2)
- This page discusses the challenges of assessing nutrient intake due to unknown requirements and variability in dietary data. It outlines two approaches: a statistical method based on Average Requirements (AR) and a qualitative interpretation of nutrient levels. Guidelines for determining nutrient adequacy are provided, including Adequate Intake (AI) and Upper Intake Levels (UL), with implications for health based on these measures.
- 6.3: Using NRVs to assess nutrient intakes of groups (8b.3)
- This page addresses the assessment of nutrient intake levels in groups to identify inadequacies or excesses. It highlights common errors in interpreting nutrient data using Reference Intakes (RIs) and recommends methods such as the Full Probability Approach and the EAR cutpoint method. The text also outlines statistical adjustments for usual nutrient intake distributions while emphasizing reliable estimates and the challenges in applying these methods across all nutrients.
- 6.4: Using the NRVs for planning nutritious diets (8b.4)
- This page details the use of Nutrient Reference Values (NRVs) for diet planning at individual and group levels to ensure nutritional adequacy while preventing excess intake. It emphasizes the importance of meeting nutrient targets for individuals and utilizing the EAR cutpoint method for groups. The planning process includes data collection, analysis, and adjustments as needed.