Since 1938 and 1941, nutrient intake recommendations have been issued to the public in Canada and the United States, respectively. Currently defined as the Dietary Reference Intakes (DRIs), these values are a set of standards established by consensus committees under the National Academies of Sciences, Engineering, and Medicine and used for planning and assessing diets of apparently healthy individuals and groups.

In 2015, a multidisciplinary working group sponsored by the Canadian and U.S. government DRI steering committees convened to identify key scientific challenges encountered in the use of chronic disease endpoints to establish DRI values. Their report, Options for Basing Dietary Reference Intakes (DRIs) on Chronic Disease: Report from a Joint US-/Canadian-Sponsored Working Group, outlined and proposed ways to address conceptual and methodological challenges related to the work of future DRI Committees. This report assesses the options presented in the previous report and determines guiding principles for including chronic disease endpoints for food substances that will be used by future National Academies committees in establishing DRIs.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON THE DEVELOPMENT OF GUIDING PRINCIPLES FOR THE INCLUSION OF CHRONIC DISEASE ENDPOINTS IN FUTURE DIETARY REFERENCE INTAKES
• Reviewers
• Preface
• Summary
  • THE TASK AND APPROACH
  • MEASURING DIETARY INTAKE AND SELECTING CHRONIC DISEASE OUTCOMES
  • EVALUATING ACCEPTABLE LEVELS OF CONFIDENCE THAT THE RELATION IS CAUSAL
  • APPROACHES TO IDENTIFY AND CHARACTERIZE THE QUANTITATIVE RELATIONSHIP AND DEVELOP DIETARY REFERENCE INTAKES
  • INTEGRATING CHRONIC DISEASE DRIs IN THE CURRENT PROCESS
  • GUIDING PRINCIPLES FOR THE PROCESS OF ESTABLISHING CHRONIC DISEASE DRIs
  • REFERENCES
• 1. Introduction
  • RATIONALE FOR SETTING CHRONIC DISEASE DIETARY REFERENCE INTAKES
  • STATEMENT OF TASK
  • APPROACH OF THE COMMITTEE
  • NUTRIENTS AND OTHER FOOD SUBSTANCES
  • ORGANIZATION OF THE REPORT
  • REFERENCES
  • ANNEX 1-1. STEPS OF THE DRI ORGANIZING FRAMEWORK
• 2. The Current Process to Establish Dietary Reference Intakes
  • EVOLUTION OF THE DRI PROCESS TO ITS CURRENT STATUS
  • SCOPE OF THE CURRENT DRI PROCESS
  • USE OF EVIDENCE TO DEVELOP DRIs: TYPES AND APPLICATIONS
  • REFERENCES
• 3. Conceptual and Methodological Challenges in Establishing Chronic Disease Dietary Reference Intakes
  • CHARACTERIZING NUTRIENT INTAKES (EXPOSURES)
  • ACCOUNTING FOR BIOLOGICAL FACTORS THAT INFLUENCE NUTRIENT EXPOSURES
  • ISOLATING EFFECTS OF SINGLE NOFS OR NOFS-CHRONIC DISEASE PATHWAYS
  • ASSESSING BIASES DUE TO STUDY DESIGNS
  • VITAMIN D CASE STUDY
  • REFERENCES
• 4. Methodological Considerations Related to Assessing Intake of Nutrients or Other Food Substances
  • METHODS TO ASSESS NUTRIENTS OR OTHER FOOD SUBSTANCES
  • IMPROVING THE QUALITY OF THE DIETARY INTAKE DATA IN NUTRITION STUDIES
  • GUIDANCE FOR FUTURE DRI COMMITTEES
  • REFERENCES
• 5. Measuring Chronic Disease Outcomes
  • CHRONIC DISEASE OUTCOMES
  • RECOMMENDATION FOR OPTIONS AND JUSTIFICATIONS
  • REFERENCES
• 6. Evidence Review: Judging the Evidence for Causal Relationships
  • OVERVIEW OF THE SYSTEMATIC REVIEW PROCESS
  • SYSTEMS OF EVIDENCE SYNTHESIS AND THEIR APPLICATIONS
  • THE “GRADE” (GRADING OF RECOMMENDATIONS, ASSESSMENT, DEVELOPMENT AND EVALUATION) SYSTEM: DEFINITION AND JUSTIFICATION
  • APPLYING THE GRADE APPROACH FOR SYNTHESIZING EVIDENCE ABOUT THE RELATIONSHIP BETWEEN AN NOFS AND CHRONIC DISEASE
  • ACCEPTABLE LEVEL OF EVIDENCE THAT THE RELATIONSHIP IS CAUSAL
  • GUIDING PRINCIPLES AS FOUNDATION FOR A CHRONIC DISEASE DRI PROCESS
  • REFERENCES
  • ANNEX 6-1. PRIORITY QUESTIONS IN THE FORMAT OF POPULATION, INTERVENTION, CONTROL, AND OUTCOMES (PICO) FOR GUIDING THE SYSTEMATIC REVIEWS IN SUPPORT OF THE WORLD HEALTH ORGANIZATION GUIDELINE ON FREE SUGARS INTAKE FOR ADULTS AND CHILDREN
  • ANNEX 6-2. ASSESSMENT TOOLS USED IN SYSTEMATIC REVIEWS
• 7. Intake-Response Relationships and Dietary Reference Intakes for Chronic Disease
  • IDENTIFYING AND DESCRIBING INTAKE-RESPONSE RELATIONSHIPS
  • EVALUATING INTAKE-RESPONSE RELATIONSHIPS: APPLYING PRINCIPLES FROM THE GRADE APPROACH
  • USING GRADE TO MOVE FROM EVIDENCE FOR INTAKE-RESPONSE RELATIONSHIP TO DRI RECOMMENDATIONS
  • POLICY CONSIDERATIONS AND IMPLEMENTATION OF DRI RECOMMENDATIONS
  • REFERENCES
  • ANNEX 7-1. EXAMPLE OF INTAKE-RESPONSE ANALYSIS
  • ANNEX 7-2. POSSIBLE NEW APPROACHES TO UL DEVELOPMENT
• 8. The Process for Establishing Chronic Disease Dietary Reference Intakes
  • CONVENING A DRI COMMITTEE AND THE ROLE OF DRI COMMITTEES
  • CONVENING OF DRI COMMITTEES: OPTIONS AND JUSTIFICATION
  • STARTING-POINT ISSUES: OPTIONS AND JUSTIFICATION
  • REFERENCES
• APPENDIXES
  • Appendix A. Open Session Agendas
  • Appendix B. Options Report
  • Appendix C. Acronyms and Abbreviations
  • Appendix D. Definitions
  • Appendix E. Biographical Sketches of Committee Members
  • Appendix F. Disclosure of Conflict of Interest

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2017. Guiding principles for developing Dietary Reference Intakes based on chronic disease. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24828.