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Defining Populations for Dietary Reference Intake Recommendations: A Letter Report

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Dietary recommendations have traditionally been designed for populations that were referred to as “healthy” or “apparently healthy”. The imprecise terminology and definition of these terms and the shift in U.S. and Canadian populations to a majority that have, or are at risk of a chronic disease is inconsistent with the goal of the DRIs. In its first letter report, the Standing Committee will offer its advice on how to define the appropriate population to be considered for dietary intake recommendations for the United States and Canada.

Description

The National Academies of Sciences, Engineering, and Medicine (NASEM) will appoint a standing committee to review the Dietary Reference Intake (DRI) framework, structure, and process relevant to future DRI reviews and produce approximately 2 letter reports a year. This first letter report will define populations for DRI recommendations in response to the following questions from the Joint Canada-US DRI Working Group and the NASEM Committee to Review the DRIs for Energy.
QUESTIONS FROM THE JOINT CANADA-US DRI WORKING GROUP:
Question 1: Who should be included in the ‘healthy population’ definition to adequately characterize the population covered by the DRIs?
Question 2: Is it assumed that sub-populations with risk factors for chronic disease (such as overweight or obesity, high blood pressure, hypercholesterolemia, or prediabetes) are considered to meet the current definition since they don’t meet the exclusion criteria?
Question 3: How should overweight and obesity be considered given the high prevalence of obesity?
Question 4: Should a different term be considered other than “apparently healthy population” since the DRIs are developed to determine the recommended intake of nutrients to meet the needs of the majority of the general population and the health status of this population has shifted?
Question 5: How should/can evidence from populations that are not “apparently healthy” be used to develop DRIs? What about data from populations with clinical disease?
Question 6: How should this definition inform the use of the DRIs for their purposes?
QUESTIONS FROM THE COMMITTEE TO REVIEW THE DRIs FOR ENERGY
Question 1: Should a DRI committee approach identifying a general/healthy population based on inclusion or exclusion criteria?
Question 2: What is the standing committee’s recommendation for managing limitations in data needed to support a rationale for recommendations?
Question 3: If data on some subpopulations are limited, how do you determine when to use the data as a criterion to exclude that group from the defined general population?
Question 4: Does the standing committee want to make a statement about using ICD Codes to exclude population groups in a DRI review?
Question 5: Are extreme outliers included in the general population? What about normal body composition when BMI </= 18.5?
Question 6: Since DRIs for energy are different from other nutrients, how should the committee manage limitations in data needed to support the rationale for a recommendation?

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Sponsors

Health Canada

U.S. Department of Agriculture - Agricultural Research Service

Staff

Ann Yaktine

Lead

Alice Vorosmarti

Melanie Arthur

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