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Dietary Reference Intake

(Redirected from Tolerable upper intake level)
For the nutritional requirements system used in the European Union and the United Kingdom, see Dietary Reference Values.

The Dietary Reference Intake (DRI) is a system of nutrition recommendations from the National Academy of Medicine (NAM)[a] of the National Academies (United States).[1] It was introduced in 1997 in order to broaden the existing guidelines known as Recommended Dietary Allowances (RDAs, see below). The DRI values differ from those used in nutrition labeling on food and dietary supplement products in the U.S. and Canada, which uses Reference Daily Intakes (RDIs) and Daily Values (%DV) which were based on outdated RDAs from 1968 but were updated as of 2016.[2]

Parameters

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Dietary Reference Intakes

DRI provides several different types of reference values:[1]

  • Estimated Average Requirements (EAR), are expected to satisfy the needs of 50% of the people in that age group based on a review of the scientific literature.
  • Recommended Dietary Allowances (RDA), the daily dietary intake level of a nutrient considered sufficient by the Food and Nutrition Board of the Institute of Medicine to meet the requirements of 97.5% of healthy individuals in each life stage and sex group. The definition implies that the intake level would cause a harmful nutrient deficiency in just 2.5%. It is calculated based on the EAR and is usually approximately 20% higher than the EAR (See Calculating the RDA).
  • Adequate Intake (AI), where no RDA has been established, but the amount established is somewhat less firmly believed to be adequate for everyone in the demographic group.
  • Tolerable upper intake levels (UL), to caution against excessive intake of nutrients (like vitamin A and selenium) that can be harmful in large amounts. This is the highest level of sustained daily nutrient consumption that is considered to be safe for, and cause no side effects in, 97.5% of healthy individuals in each life stage and sex group. The definition implies that the intake level would cause a harmful nutrient excess in just 2.5%. The European Food Safety Authority (EFSA) has also established ULs which do not always agree with U.S. ULs. For example, adult zinc UL is 40 mg in the U.S. and 25 mg in EFSA.[3]
  • Acceptable Macronutrient Distribution Ranges (AMDR), are a range of intake specified as a percentage of total energy intake. Used for sources of energy, such as fats and carbohydrates.

DRIs are used by both the United States and Canada, and are intended for the general public and health professionals. Applications include:

  • Composition of diets for schools, prisons, hospitals or nursing homes
  • Industries developing new foods and dietary supplements
  • Healthcare policy makers and public health officials

Other countries

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The European Food Safety Authority (EFSA) refers to the collective set of information as Dietary Reference Values, with Population Reference Intake (PRI) instead of RDA, and Average Requirement instead of EAR. AI and UL define the same as in the United States, although numerical values may differ.[4][3]

Australia and New Zealand refer to the collective set of information as Nutrient Reference Values, with Recommended Dietary Intake (RDI) instead of RDA, but EAR, AI and UL defined the same as in the United States and Canada, although numerical values may differ.[5]

History

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The recommended dietary allowance (RDA) was developed during World War II by Lydia J. Roberts, Hazel Stiebeling, and Helen S. Mitchell, all part of a committee established by the United States National Academy of Sciences in order to investigate issues of nutrition that might "affect national defense".[6]

The committee was renamed the Food and Nutrition Board in 1941, after which they began to deliberate on a set of recommendations of a standard daily allowance for each type of nutrient. The standards would be used for nutrition recommendations for the armed forces, for civilians, and for overseas population who might need food relief. Roberts, Stiebeling, and Mitchell surveyed all available data, created a tentative set of allowances for "energy and eight nutrients", and submitted them to experts for review (Nestle, 35).

The final set of guidelines, called RDAs for Recommended Dietary Allowances, were accepted in 1941. The allowances were meant to provide superior nutrition for civilians and military personnel, so they included a "margin of safety". Because of food rationing during the war, the food guides created by government agencies to direct citizens' nutritional intake also took food availability into account.[citation needed]

The Food and Nutrition Board subsequently revised the RDAs every five to ten years. In the early 1950s, United States Department of Agriculture nutritionists made a new set of guidelines that also included the number of servings of each food group in order to make it easier for people to receive their RDAs of each nutrient.[citation needed]

The DRI was introduced in 1997 in order to broaden the existing system of RDAs. DRIs were published over the period 1998 to 2001. In 2011, revised DRIs were published for calcium and vitamin D.[7] Additionally, revised DRIs were published for potassium and sodium in 2019. [8] The DRI for energy was updated in 2023. [9] None of the other DRIs have been revised since first published 1998 to 2001.

Current recommendations for United States and Canada

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Highest EARs and RDA/AIs and lowest ULs for people ages nine years and older, except pregnant or lactating women. ULs for younger children may be lower than RDA/AIs for older people. Females need more iron than males and generally need more nutrients when pregnant or lactating.[10][11]

Vitamins and choline

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Nutrient Highest EAR Highest RDA/AI Lowest UL Unit Top common sources, 100 grams, U.S. Department of Agriculture (USDA)[12]
Males Females
Vitamin A 630 900 700[b] 1700[c] μg cod liver oil, liver, dehydrated red sweet peppers, veal, dehydrated carrots
Thiamin (B1) 1.0 1.2 1.1[d] ND mg fortified breakfast cereals, energy bars, and baby food products
Riboflavin (B2) 1.1 1.3 1.1[e] ND mg fortified food products, lamb liver, spirulina
Niacin (B3) 12 16 14[f] 20[g] mg fortified food products, baker's yeast, rice bran, instant coffee, fortified beverages
Pantothenic acid (B5) NE 5 5[h] ND mg fortified food and beverage products, dried shiitake mushrooms, beef liver, rice bran
Vitamin B6 1.4 1.7 1.5[i] 60 mg fortified food and beverage products, rice bran, fortified margarines, ground sage
Biotin (B7) NE 30 30[j] ND μg organ meats, eggs, fish, meat, seeds, nuts[13]
Folate (B9) 330 400 400[k] 600[l] μg baker's yeast, fortified food and beverage products, poultry liver
Cobalamin (B12) 2.0 2.4 2.4[m] ND μg shellfish, beef, animal liver, fortified food and beverage products
Vitamin C 75 90 75[n] 1200 mg fortified beverages, dried sweet peppers, raw acerola, dried chives and coriander, rose hips, fortified food products
Vitamin D 10 20 20 100 μg cod liver oil, mushrooms (if exposed to ultraviolet light), halibut, mackerel, canned sockeye salmon
α-tocopherol (Vitamin E) 12 15 15[o] 600 mg wheat germ oil, fortified food and beverage products, hazelnut oil, fortified peanut butter, chili powder
Vitamin K NE 120 90 ND μg dried spices, fresh parsley, cooked and raw kale, chard, other leaf vegetables
Choline NE 550 425[p] 2000 mg egg yolk, organ meats from beef and pork, soybean oil, fish roe

Minerals

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Nutrient Highest EAR Highest RDA/AI Lowest UL Unit Top common sources, 100 grams, U.S. Department of Agriculture (USDA)[12]
Males Females
Calcium 1100 1300 1300 2000 mg fortified cereals, beverages, tofu, energy bars, and baby foods, dried basil and other spices, dried whey, cheese, milk powder
Chloride NE 2300 2300 3400 mg table salt
Chromium NE 35 25[q] ND μg broccoli, turkey ham, dried apricots, tuna, pineapple, grape juice[14]
Copper 700 900 900[r] 5000 μg animal liver, seaweed products, dried shiitake mushrooms, oysters, sesame seeds, cocoa powder, cashews, sunflower seeds
Fluoride NE 4 3 10[s] mg public drinking water, where fluoridation is performed or natural fluorides are present, tea, raisins
Iodine 95 150 150[t] 600 μg iodized salt, kelp, cod
Iron 8.1 11 18[u] 40 mg dried thyme and other spices, fortified foods, including baby foods, animal organ meats
Magnesium 350 420 360[v] 350[w] mg crude rice bran, cottonseed flour, hemp seeds, dried spices, cocoa powder, fortified beverages
Manganese NE 2.3 1.8[x] 6[y] mg fortified beverages and infant formulas, ground cloves and other dried spices, chickpeas, fortified breakfast cereals
Molybdenum 34 45 45[z] 1100 μg legumes, grain products, nuts and seeds[15]
Phosphorus 1055 1250 1250 3000 mg baking powder, instant pudding, cottonseed meal, hemp seeds, fortified beverages, dried whey
Potassium NE 3400 2600[aa] ND mg Potatoes, bananas, kiwifruit, prunes, raisins, sunflower seeds, watermelon, avocado, spinach, baking powder, dried parsley and other spices, cocoa solids, instant tea and instant coffee, dried tomatoes, dried sweet peppers, soy sauce
Selenium 45 55 55[ab] 280[ac] μg Brazil nuts and mixed nuts, animal kidneys, dried eggs, oysters, dried cod
Sodium NE 1500 1500 1800[ad] mg table salt, baking soda, soup bouillon cube, seasoning mixes, onion soup mix, fish sauce
Zinc 9.4 11 9[ae] 40[af] mg oysters, fortified breakfast cereals, baby foods, beverages, peanut butter, and energy bars, wheat germ

NE: EARs have not yet been established or not yet evaluated; ND: ULs could not be determined, and it is recommended that intake from these nutrients be from food only, to prevent adverse effects.

It is also recommended that the following substances not be added to food or dietary supplements. Research has been conducted into adverse effects, but was not conclusive in many cases:

Substance Lowest UL units per day
Arsenic ND —
Boron 11 mg
Nickel 0.6 mg
Silicon ND —
Vanadium 1.8 mg

Macronutrients

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RDA/AI is shown below for males and females aged 19–50 years.[10][17][18]

Substance Amount (males) Amount (females) Top Sources in Common Measures[12]
Water[i] 3.7 L/day 2.7 L/day water, watermelon, iceberg lettuce, fruits and vegetables
Carbohydrates 45–65% of calories[ii] milk, grains, fruits, vegetables
130 g/day[iii]
Protein 10–35% of calories[ii] Nuts, seeds legumes (pulses: beans, peas, lentils). Animal sources: Meats, fish, milk, cheeses, eggs
56 g/day[iv] 46 g/day[iv]
Fiber 14 g/(1000 kcal) barley, bulgur, rolled oats, legumes, psyllium, nuts, beans, apples
38 g/day[v] 25 g/day[vi]
Fat 20–35% of calories[ii] Vegetable oils, butter, lard, nuts, seeds, fatty meat cuts, egg yolk, cheeses
Linoleic acid, an omega-6 fatty acid (polyunsaturated) (A type of fat) 17 g/day 12 g/day Vegetable oils (Hemp oil (seed), sunflower oil (seed), corn oil (maize), canola oil)
alpha-Linolenic acid, an omega-3 fatty acid (polyunsaturated) (A type of fat) 1.6 g/day 1.1 g/day Vegetable oils: (Linseed oil (flax seed), hemp oil (seed), canola oil), chia seed, hemp seed, walnut, soybeans
Trans fatty acids (A type of fat) As low as possible[20] Partially hydrogenated fat, margarine
Saturated fatty acids (A type of fat) As low as possible while consuming a nutritionally adequate diet Animal fat (dairy products), fully hydrogenated fat, coconut oil (meat), cocoa butter, palm oil
Added sugar (A type of carbohydrate) Less than 10% of calories[21] non-natural sweet foods: Candy, sweetened beverages, cookies, cakes, jams, syrup, many processed foods
  1. ^ equal to median intakes and includes water from solid food
  2. ^ a b c Acceptable Macronutrient Distribution Range (AMDR).
  3. ^ based on the average minimum glucose used by the brain, which is similar to the amount that has a maximum protein sparing effect and to the amount derived from nitrogen balance[19]
  4. ^ a b Based on 0.8 g/kg of body weight (RDA).
  5. ^ using a median intake of 2,718 kcal for men 19 to 30 years of age
  6. ^ using a median intake of 1,757 kcal for women 19 to 30 years of age

Calculating the RDA

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The equations used to calculate the RDA are as follows:

"If the standard deviation (SD) of the EAR is available and the requirement for the nutrient is symmetrically distributed, the RDA is set of two SDs above the EAR:

 

If data about variability in requirements are insufficient to calculate an SD, a coefficient of variation (CV) for the EAR of 10 percent is assumed, unless available data indicate a greater variation in requirements. If 10 percent is assumed to be the CV, then twice that amount when added to the EAR is defined as equal to the RDA. The resulting equation for the RDA is then

 

This level of intake statistically represents 97.5 percent of the requirements of the population."[22]

Standard of evidence

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In September 2007, the Institute of Medicine held a workshop entitled "The Development of DRIs 1994–2004: Lessons Learned and New Challenges".[23] At that meeting, several speakers stated that the current Dietary Recommended Intakes (DRI's) were largely based upon the very lowest rank in the quality of evidence pyramid, that is, opinion, rather than the highest level – randomized controlled clinical trials. Speakers called for a higher standard of evidence to be utilized when making dietary recommendations. The only DRIs to have been revised since that meeting until 2011 are vitamin D and calcium.[7]

Adherence

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Percent of U.S. population ages 2+ meeting EAR or USDA healthy eating patterns in 2004[24]

Nutrient Adherence
Protein 88.9%
Vitamin A 46.0%
Vitamin C 51.0%
Vitamin E 13.6%
Thiamin 81.6%
Riboflavin 89.1%
Niacin 87.2%
Vitamin B6 73.9%
Folate 59.6%
Vitamin B12 79.7%
Phosphorus 87.2%
Magnesium 43.0%
Iron 89.5%
Selenium 91.5%
Zinc 70.8%
Copper 84.2%
Calcium 30.9%
Fiber 8.0%
Potassium 7.6%
% calories from total fat ≤ 35% 59.4%
% calories from saturated fat < 10% 55.8%
Cholesterol intake < 300 mg 10.4%
Sodium intake ≤ 2,300 mg 29.8%

See also

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Notes

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  1. ^ formerly the Institute of Medicine (IoM)
  2. ^ 1300 for pregnant or lactating women
  3. ^ 600 for children aged 8 years and younger
  4. ^ 1.4 for pregnant or lactating women
  5. ^ 1.6 for pregnant or lactating women
  6. ^ 18 for pregnant or lactating women
  7. ^ 10 for children aged 8 years and younger
  8. ^ 7 for pregnant or lactating women
  9. ^ 2.0 for pregnant or lactating women
  10. ^ 35 for lactating women
  11. ^ 600 for pregnant or lactating women
  12. ^ 300 for children aged 8 years and younger
  13. ^ 2.8 for pregnant or lactating women
  14. ^ 120 for pregnant or lactating women
  15. ^ 19 for lactating women
  16. ^ 550 for pregnant or lactating women
  17. ^ 45 for pregnant or lactating women
  18. ^ 1300 for pregnant or lactating women
  19. ^ 0.7 for children aged 3 years and younger, 2.2 for children aged 4-8 years
  20. ^ 290 for pregnant or lactating women
  21. ^ 27 for pregnant women
  22. ^ 400 for pregnant or lactating women
  23. ^ Specific to consuming more than this amount all at once, in the form of a dietary supplement, as this may cause diarrhea. Magnesium-rich foods do not cause this problem. 65 for children aged 3 and younger, 110 for children aged 4-8 years.
  24. ^ 2.6 for pregnant or lactating women
  25. ^ 2 for children aged 8 years and younger
  26. ^ 50 for pregnant or lactating women
  27. ^ 2900 for pregnant or lactating women
  28. ^ 70 for pregnant or lactating women
  29. ^ 45 for children aged 8 years and younger
  30. ^ The UL for sodium toxicity is not established; however, the lowest Chronic Disease Risk Reduction Intake (CDRR) for sodium is 1800 mg for people ages 9 and up. 1200 for children aged 8 years and younger.[16]
  31. ^ 13 for pregnant or lactating women
  32. ^ 4 for children aged 3 years and younger

References

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  1. ^ a b "A Consumer's Guide to the DRIs (Dietary Reference Intakes)". Health Canada. 2010-11-29. Retrieved 2017-08-29.
  2. ^ "Federal Register, Food Labeling: Revision of the Nutrition and Supplement Facts Labels. FR page 33982" (PDF). US Food and Drug Administration. 27 May 2016.
  3. ^ a b Tolerable Upper Intake Levels For Vitamins And Minerals (PDF), European Food Safety Authority, 2006
  4. ^ "Overview on Dietary Reference Values for the EU population as derived by the EFSA Panel on Dietetic Products, Nutrition and Allergies" (PDF). 2017.
  5. ^ "Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes" (PDF). Australian Government, Department of Health and Ageing. September 2017.
  6. ^ Harper AE (November 2003). "Contributions of women scientists in the U.S. to the development of Recommended Dietary Allowances". J. Nutr. 133 (11): 3698–702. doi:10.1093/jn/133.11.3698. PMID 14608098.
  7. ^ a b Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Ross, A. C.; Taylor, C. L.; Yaktine, A. L.; Del Valle, H. B. (2011). Dietary Reference Intakes for Calcium and Vitamin D. Washington DC: National Academy Press. doi:10.17226/13050. ISBN 978-0-309-16394-1. PMID 21796828. S2CID 58721779. ..., The IOM finds that the evidence supports a role for vitamin D and calcium in bone health but not in other health conditions. Further, emerging evidence indicates that too much of these nutrients may be harmful, challenging the concept that "more is better".
  8. ^ Stallings, Virginia A.; Harrison, Meghan; Oria, Maria, eds. (2019). Dietary Reference Intakes for Sodium and Potassium. Washington DC: National Academy Press. doi:10.17226/25353. ISBN 978-0-309-48834-1. PMID 30844154. S2CID 104464967.
  9. ^ Dietary Reference Intakes for Energy. Washington DC: National Academy Press. 2023. doi:10.17226/26818. ISBN 978-0-309-69723-1. PMID 36693139.
  10. ^ a b "Nutrient Recommendations: Dietary Reference Intakes (DRI)". National Institutes of Health. HHS. Retrieved May 31, 2021.
  11. ^ "Dietary Reference Intakes (DRIs)" (PDF). usda.gov. Archived from the original (PDF) on May 26, 2022. Retrieved May 31, 2021.
  12. ^ a b c "Search ordered by selected nutrient per 100 gram amounts: sort by nutrient among all foods, USDA National Nutrient Database for Standard Reference, SR28". 2016. Retrieved 28 October 2017.
  13. ^ "Biotin, Fact Sheet for Health Professionals". Office of Dietary Supplements, US National Institutes of Health. 3 October 2017. Retrieved 28 October 2017.
  14. ^ "Chromium". Micronutrient Information Center, Linus Pauling Institute, Oregon State University. 22 April 2014.
  15. ^ "Molybdenum". Micronutrient Information Center, Linus Pauling Institute, Oregon State University. 23 April 2014.
  16. ^ "Summary". Dietary Reference Intakes for Sodium and Potassium. NIH. 5 March 2019. Retrieved June 1, 2021. {{cite book}}: |website= ignored (help)
  17. ^ Dietary Reference Intakes (DRIs): Recommended Intakes for Individuals, Food and Nutrition Board, Institute of Medicine, National Academies, 2004, archived from the original on 2017-10-21, retrieved 2009-06-09
  18. ^ Dietary Guidelines for Americans, 2020-2025. 9th Edition. U.S. Department of Agriculture and U.S. Department of Health and Human Services. December 2020.
  19. ^ Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, D.C.: The National Academies Press. 2005. pp. 265–290. doi:10.17226/10490. ISBN 978-0-309-08525-0. Retrieved June 9, 2021.
  20. ^ As of 2018 partially hydrogenated oils (PHOs), a specific source of TFAs, although the major one, are no longer Generally Recognized as Safe (GRAS).
  21. ^ "Acceptable Macronutrient Distribution Ranges" (PDF). usda.gov. USDA. Archived from the original (PDF) on May 26, 2022. Retrieved June 9, 2021.
  22. ^ Institute of Medicine (US) Panel on Micronutrients (2001). Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. National Academy Press. doi:10.17226/10026. ISBN 978-0-309-07279-3. PMID 25057538. S2CID 44243659.
  23. ^ Read "The Development of DRIs 1994-2004: Lessons Learned and New Challenges: Workshop Summary" at NAP.edu. 2008. doi:10.17226/12086. ISBN 978-0-309-11562-9 – via www.nap.edu.
  24. ^ "California". Community Nutrition Mapping Project. USDA Agricultural Research Service. "All U.S." column. Retrieved 6 Nov 2014.
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