Rethinking the Acceptable Macronutrient Distribution Range for the 21st Century: A Letter Report (2024)
Chapter: 6 Recommendations and Considerations
6
Recommendations and Considerations
The committee was tasked to consider “whether the Acceptable Macronutrient Distribution Range (AMDR) is necessary within the expanded Dietary Reference Intake (DRI) framework that includes chronic disease risk reduction considerations.” In response to this charge, the committee considered evidence given by users of the AMDR about whether or how they apply the value to their respective population groups, evidence from the peer-reviewed published literature, and the experience and expertise represented on the committee.
FINDINGS AND CONCLUSIONS
Findings
The committee found that users of the AMDRs reported they applied the values as a primary or secondary tool for assessment of diets or for dietary planning. Some users of the AMDR reported that it provided a check for dietary quality after using other DRI values to evaluate adequacy, safe upper levels of intake, and/or chronic disease risk reduction.
The AMDR recommendations were predicated on a narrative literature review that yielded estimates based on subjective interpretation of the data (IOM 2002/2005; chapter 11). A concern recognized by the committee was that except for essential fatty acids, the AMDR concept was not linked to macronutrient quality. Applying the AMDRs is another concern because guidance on using DRIs in dietary assessment and plan-
ning is based on distributions and probability, and the AMDRs do not fit this paradigm. These issues were not addressed in documentation of the development of the AMDR values.
Conclusion
The committee concludes that the approach used to derive the AMDRs is not consistent with current evidence-based standards. A future DRI review of macronutrients and their constituent nutrients and other food substances needs to consider the quality and strength of the evidence associated with chronic disease risk.
RECOMMENDATIONS
Recommendation 1: In developing future reviews of Dietary Reference Intakes (DRIs) for macronutrients, the federal DRI working group should remove the Acceptable Macronutrient Distribution Range from the panel of nutrient intake values considered in the DRI framework.
Recommendation 2: In future reviews of Dietary Reference Intakes for macronutrients, the expert review panel should consider macronutrient quality, the requirement for essential nutrients associated with macronutrient intake, and the reference values for their constituent nutrients and other food substances as supported by the evidence.
CONSIDERATIONS
The committee recognizes that in the interim, and until an alternative approach is provided, some users may wish to continue to apply the AMDR values. However, users should realize their limitations if they continue to employ these ranges. The committee suggests the use of existing DRIs (e.g., Estimated Energy Requirement [EER], Estimated Average Requirement [EAR], Recommended Dietary Allowance [RDA], Adequate Intake [AI], Tolerable Upper Intake Level [UL], Chronic Disease Risk Reduction [CDRR]), as appropriate, for dietary assessment and planning. If there is a well-defined need for an alternative to the AMDR, it should be in the purview of the relevant DRI macronutrient expert review panel.
