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Given the focus on developing Dietary Reference Intakes (DRIs) based on chronic disease risk reduction and recent research for omega-3 long chain PUFA since the last DRI review, the Canadian Nutrition Society convened a panel of stakeholders for a 1-day workshop in late 2019. Attendees discussed the new NASEM guidelines for establishing DRI values based on chronic disease risk endpoints and the strength of current evidence for EPA and DHA as it relates to the new guidelines. Novelty: Summarizes evidence and expert opinions regarding the potential for reviewing DRI values for EPA and DHA and cardiovascular disease risk and early development.

Dietary bioactives are food substances that promote health but are not essential to prevent typical deficiency conditions. Examples include lutein and zeaxanthin, omega-3 fatty acids, and flavonoids. When quality evidence is available, quantified intake recommendations linking dietary bioactives with specific health benefits will enable health professionals to provide evidence-based information to consumers. Without evidence-based recommendations, consumers use information from available sources that often lack standards and rigor. This article describes a framework to develop guidance based on quality evidence fully vetted for efficacy and safety by qualified experts, and designed to communicate the amounts of specific dietary bioactive compounds with identified health benefits. The 4-step Framework described here can be adapted by credible health organizations to work within their guideline development process. Standards of practice used in clinical guidelines are adapted to quantify dietary bioactive intake recommendations from foods consumed by the general public, by taking into account that side effects and trade-offs are often needed for medical treatments but are not acceptable for dietary bioactives. In quantifying dietary bioactive recommendations, this Framework establishes 4 decision-making steps: 1) characterize the bioactive, determine amounts in specific food sources, and quantify intakes; 2) evaluate safety; 3) quantify the causal relation between the specific bioactive and accepted markers of health or normal function via systematic evidence reviews; and 4) translate the evidence into a quantified bioactive intake statement. This Framework provides a working model that can be updated as new approaches are advanced., Statement of Significance: A credible step-by-step process for translating evidence into quantified dietary bioactive intake recommendations is provided; the approach is relevant to nutrition guidance developers globally.

To investigate the outcomes of 34 patients with intestinal failure secondary to advanced peritoneal malignancy on home parenteral nutrition (HPN). A retrospective analysis of all known patients receiving HPN at any time between January 2012 and the 31st March 2020 registered in a high volume peritoneal malignancy surgical centre database. The median duration of HPN for all patients was 309.5 days (range 31–2198). Overall 11/34 went on to have multivisceral transplants. Of these 5/11 resumed normal oral intake off HPN, 3 died and 3 required ongoing HPN. Average time on HPN for patients with pseudomyxoma peritonei of appendix origin was 338 days (71–2198) compared with 90 days (31–260) in the group with more aggressive tumours. HPN is feasible and effective in selected patients with pseudomyxoma peritonei as either a bridge to transplant or definitive treatment. As expected, patients with more aggressive tumours fare worse.

There is increasing interest by consumers, researchers, and regulators into the roles that certain bioactive compounds, derived from plants and other natural sources, can play in health maintenance and promotion, and even prolonging a productive quality of life. Research has rapidly emerged suggesting that a wide range of compounds and mixtures in and from plants (such as fruits and vegetables, tea and cocoa) and animals (such as fish and probiotics) may exert substantial health benefits. There is interest in exploring the possibility of establishing recommended intakes or dietary guidance for certain bioactive substances to help educate consumers. A key aspect of establishing dietary guidance is the assessment of safety/toxicity of these substances. Toxicologists need to be involved in both the development of the safety framework and in the evaluation of the science to establish maximum intake/upper limits.

BackgroundTo analyse the duration of parenteral nutrition (PN) in patients treated for peritoneal malignancy with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) over a 2 year period at a single UK National referral centre.MethodsA retrospective analysis of prospective data for all patients (n=321) who underwent CRS and HIPEC for peritoneal malignancy at the Peritoneal Malignancy Institute Basingstoke between April 1, 2013 and March 31, 2015.Duration of PN was compared between primary tumour site (appendix, colorectal, mesothelioma and other); completeness of CRS (complete CRS vs. major tumour debulking) and pre-operative nutritional assessment measures (including Mid Upper Arm Circumference).ResultsThe median duration of PN was 9 days (range 2–87 days). A total of 13 % of patients had PN for less than 7 days and 6 % for 5 days or less. There was no significant difference in duration of PN between the different tumour sites. Two factors that may increase the duration of PN include having major tumour debulking (MTD) and a baseline MUACConclusionsMost patients who underwent CRS and HIPEC for peritoneal malignancy required PN for more than 7 days with poor pre-operative nutritional status and inability to achieve complete cytoreduction predictors of prolonged PN requirements.

The Dietary Reference Intakes (DRIs) are reference values to guide the planning and assessing of nutrient intakes in the United States and Canada. The DRI framework was conceptualized in 1994, and the first reports were issued from 1997–2004, based on work by expert panels and subcommittees under the guidance of the Food and Nutrition Board of the Institute of Medicine. Numerous conventions, challenges, and controversies were encountered during the process of defining and setting the DRIs, including the definition of the framework, the use of chronic disease endpoints, lack of data on requirements for children and youth, and methods for addressing nonessential bioactive substances with potential health benefits. DRIs may be used to plan and assess the nutrient intakes of both individuals and population groups, but the new paradigm particularly improved methods used for groups. It is now possible to estimate both the prevalence of inadequate intake and the prevalence of potentially excessive intake within a group. The DRIs have served as a potent influence on national nutrition policies, including those related to dietary guidance, food labeling, nutrition monitoring, food assistance programs, and military nutrition standards. Because of this important impact on nutrition policy, the DRIs must be based on the best possible and most up-to-date science. Unfortunately, no updates to specific DRIs are currently planned. Despite the long and challenging road that led to the current DRIs, it must not finish in a dead end. Monetary resources and political will are crucial to maintaining and continuously updating the DRIs.

One of the most important of the nutrient intake values (NIVs) is the average nutrient requirement (ANR). The ANR is defined as an intake value that will be adequate for half of the individuals in a group of people with similar characteristics. It is used to estimate the prevalence of adequacy, and it serves as the basis for the individual nutrient level (INLx). The determination of adequacy is a complex process, with the resulting value of the ANR dependent on the criterion or functional outcome chosen to define nutrient adequacy. Because nutrients have multiple sites of action in human metabolism, it is possible to demonstrate abnormal function in one parameter measured or observed as a result of inadequate intake of a nutrient, while other parameters requiring the same nutrient appear normal or within normal ranges. Thus, depending on the criterion of adequacy selected, the requirement for a given nutrient may be at a lower or a higher intake amount. In harmonizing development of NIVs, it is important to clearly identify the criterion of adequacy selected and the rationale for its selection. Rarely are available data sufficient to provide dose—response information from which to select a level of intake at which half of the individuals demonstrate adequacy and half appear to demonstrate inadequacy. Three levels of intake, of which at least one level of intake is below the requirement for most of the individuals in the sample, and one level of intake is above their requirement, are useful for establishing a level at which half of the group might be considered to demonstrate adequacy. Types of human nutrient studies that may be used to obtain data are discussed, as well as characteristics of the sample size needed to demonstrate adequacy. The variation in requirements is also an important aspect in predicting levels of intake that will have defined probabilities of adequacy for groups (to develop the INLx, where x is the defined probability chosen). An analysis of the origins of different types of variability is presented. When estimating energy requirements, a special case of NIVs, important issues must be considered. Additionally, an example of evaluating data used to establish an ANR for vitamin A, and the effect of variability in requirements for vitamin A, is provided.

Dietary Reference Intakes (DRIs) represent the new approach adopted by the Food and Nutrition Board to providing quantitative estimates of nutrient intakes for use in a variety of settings, replacing and expanding on the past 50 years of periodic updates and revisions of the Recommended Dietary Allowances (RDAs). The DRI activity is a comprehensive effort undertaken to include current concepts about the role of nutrients and food components in long-term health, going beyond deficiency diseases. The DRIs consist of 4 reference intakes: the RDA, which is to be used as a goal for the individual; the Tolerable Upper Intake Level (UL), which is given to assist in advising individuals what levels of intake may result in adverse effects if habitually exceeded; the Estimated Average Requirement (EAR), the intake level at which the data indicate that the needs for 50% of those consuming it will not be met; and the Adequate Intake (AI), a level judged by the experts developing the reference intakes to meet the needs of all individuals in a group, but which is based on much less data and substantially more judgment than that used in establishing an EAR and subsequently the RDA. When an RDA cannot be set, an AI is given. Both are to be used as goals for an individual. Two reports have been issued providing DRIs for nutrients and food components reviewed to date: these include calcium and its related nutrients: phosphorus, magnesium, vitamin D, and fluoride; and most recently, folate, the B vitamins, and choline. The approaches used to determine the DRIs, the reference values themselves, and the plans for future nutrients and food components are discussed. J Am Diet Assoc. 1998;98: 699–706 .

Dietary Reference Intakes (DRIs) represent the new approach adopted by the Food and Nutrition Board to providing quantitative estimates of nutrient intakes for use in a variety of settings, replacing and expanding on the past 50 years of periodic updates and revisions of the Recommended Dietary Allowances (RDAs). The DRI activity is a comprehensive effort undertaken to include current concepts about the role of nutrients and food components in long-term health, going beyond deficiency diseases. The DRIs consist of 4 reference intakes: the RDA, which is to be used as a goal for the individual; the Tolerable Upper Intake Level (UL), which is given to assist in advising individuals what levels of intake may result in adverse effects if habitually exceeded; the Estimated Average Requirement (EAR), the intake level at which the data indicate that the needs for 50% of those consuming it will not be met; and the Adequate Intake (AI), a level judged by the experts developing the reference intakes to meet the needs of all individuals in a group, but which is based on much less data and substantially more judgment than that used in establishing an EAR and subsequently the RDA. When an RDA cannot be set, an AI is given. Both are to be used as goals for an individual. Two reports have been issued providing DRIs for nutrients and food components reviewed to date: these include calcium and its related nutrients: phosphorus, magnesium, vitamin D, and fluoride; and most recently, folate, the B vitamins, and choline. The approaches used to determine the DRIs, the reference values themselves, and the plans for future nutrients and food components are discussed.

The dietary reference intakes (DRIs) are a set of reference intake levels for nutrients that can be used for planning diets and assessing nutrient inadequacies of individuals and groups. Since the publication of the DRI reports 1997–2004, the reference intake levels have been used for various purposes. While DRIs have been used appropriately for planning and assessing diets for many different situations, there have been instances in which specific DRI categories have not been applied as intended. In this review, cases are described in which DRIs were applied correctly, as well as cases from the growing number of examples in which the wrong DRI was used or DRIs were used incorrectly.

This review examines issues related to the development of a recommended daily allowance or adequate intake, two of the categories of dietary reference intakes, for the long-chain omega-3 polyunsaturated fatty acids (omega-3 PUFAs), eicosapentaenoic acid (EPA, 20:5 n-3), and docosahexaenoic acid (DHA, 22:6 n-3). Although some have suggested a dietary intake of two servings of fatty fish per week or supplement intake of 500 mg/day EPA plus DHA, based on evidence from epidemiologic and clinical studies of cardiovascular benefit from regular fish or fish-oil consumption, supplementation with EPA and/or DHA may also have antidepressant and mood-stabilizing effects. Omega-3 PUFA biology is complex and chronic disease outcomes are sometimes difficult to prove, yet the possibility of benefit for a substantial portion of the population from increased omega-3 PUFA intake is a public health issue that must be addressed responsibly and be based on significant scientific evidence.

Many countries such as The Republic of Korea have established their own nutritional standards, collectively termed Nutrient Reference Values(NRVs), and they vary due to the science which was reviewed, the purposes for which they are developed, and issues related to nutrition and food policy in the country. The current effort by the Codex Alimentarius Committee on Nutrition and Foods for Special Dietary Uses (CNFSDU) to update the NRVs that were established following the Helsinki Consultation in 1988 represents an opportunity to develop a set of reference values reflecting current scientific information to be used or adapted by many countries. This paper will focus on possible approaches to selecting or developing reference values which would serve the intended purpose for nutrition labeling to the greatest extent possible. Within the United States, the Food and Drug Administration (U.S. FDA) is currently reviewing regulations on nutrition labeling to better address current health issues, and is expected to enter into a process in the next few months to begin to explore how best to update nutrient Daily Values (DVs), most of which are still based on the Recommended Dietary Allowances (RDAs) of the Food and Nutrition Board, U.S. National Academy of Sciences, last reviewed and revised in 1968. In this presentation, I review the current purposes in the U.S. for nutrition labeling as identified in the 1938 Food, Drug, and Cosmetic Act as amended, the scientific basis for current nutrition labeling regulations in the United States, and the recommendations made by the recent Committee on Use of Dietary Reference Intakes in Nutrition Labeling of the Institute of Medicine (2003) regarding how to use the DRIs in developing new DVs to be used on the label in the United States and Canada. Based on these reviews, I then provide examples of the issues that arise in comparing one approach to another. Much of the discussion focuses on the appropriate role of nutrient labeling within the Nutrition Facts panel, one of the three major public nutrition education tools in the United States (along with MyPyramid and Dietary Guidelines for Americans).

The U.S. Food and Drug Administration is currently reviewing regulations on nutrition labeling to better address current health issues as well as updating nutrient daily values (DVs), most of which are still based on recommended dietary allowances (RDAs) established in 1968. In 2003 the Committee on Use of Dietary Reference Intakes in Nutrition Labeling of the Institute of Medicine recommended that the DVs be based on the estimated average requirement (EAR) rather than the RDA and that a population-weighted mean of EARs be used. The rationale given is that the EAR is the best statistical approximation of the nutrient requirement for any one individual in the population, and its use would result in a food appearing more nutritious, as it would provide a greater percentage of the DV if the DV were a smaller amount. Concerns about these recommendations focus on the appropriate role of the Nutrition Facts panel, 1 of the 3 major public nutrition education tools in the United States (along with MyPyramid and Dietary Guidelines for Americans). Providing a benchmark or standard that knowingly has only a 50% chance of meeting a consuming individual's requirement is not appropriate. The DV on a Nutrition Facts panel should provide useful guidance to the individual about how a serving will assist in meeting that person's goal for consumption, and thus it should be based on the RDA or adequate intake, rather than the EAR, and be derived from the highest recommended intake, as has been the practice since 1973. J. Nutr. 136: 2457-2462, 2006.

Nutrient reference values provide guidance for maintaining and enhancing health via standard setting and development of nutritionally improved products to decrease the risk of disease. Since 1941, the Food and Nutrition Board (FNB) of the National Academy of Sciences in the United States has developed and periodically revised recommendations for nutrients; the last (10th) edition of the Recommended Dietary Allowances (RDA) was released in 1989. In 1994 the FNB initiated an expanded approach to develop dietary reference intakes (DRI), quantitative nutrient intakes that include concepts of chronic disease risk and multiple reference values more specifically suited to various applications. In concert with Canadian scientists, 10 DRI reports have been completed since 1997 and are available for review at www.nap.edu. The DRI reports explicitly review possible functional endpoints considered in determining the adequacy of each nutrient, and differentiate between the statistical basis for assessing the adequacy of intakes for individuals and groups and providing recommended intakes, as well as levels of nutrient intake that should not be exceeded. Recommended intakes for infants are based on average volumes of intake by healthy, full-term, exclusively breast-fed infants and nutrient analysis of human milk; the recommended intake also includes nutrients contributed by complementary foods consumed during the second 6-month period of life.

Nutrient reference values provide guidance for maintaining and enhancing health via standard setting and development of nutritionally improved products to decrease the risk of disease. Since 1941, the Food and Nutrition Board (FNB) of the National Academy of Sciences in the United States has developed and periodically revised recommendations for nutrients; the last (10th) edition of the Recommended Dietary Allowances (RDA) was released in 1989. In 1994 the FNB initiated an expanded approach to develop dietary reference intakes (DRI), quantitative nutrient intakes that include concepts of chronic disease risk and multiple reference values more specifically suited to various applications. In concert with Canadian scientists, 10 DRI reports have been completed since 1997 and are available for review at www.nap.edu. The DRI reports explicitly review possible functional endpoints considered in determining the adequacy of each nutrient, and differentiate between the statistical basis for assessing the adequacy of intakes for individuals and groups and providing recommended intakes, as well as levels of nutrient intake that should not be exceeded. Recommended intakes for infants are based on average volumes of intake by healthy, full-term, exclusively breast-fed infants and nutrient analysis of human milk; the recommended intake also includes nutrients contributed by complementary foods consumed during the second 6-month period of life.

A shortage of credible information exists on practical dietary and physical activity patterns that have potential to reverse the national obesity epidemic and reduce the risk of major cancers and other chronic diseases. Securing such information is a challenging task, and there is considerable diversity of opinion concerning related research designs and priorities. Here, we put forward some perspectives on useful methodology and infrastructure developments for progress in this important area, and we list high-priority research topics in the areas of 1) assessment of nutrient intake and energy expenditure; 2) development of intermediate outcome biomarkers; 3) enhancement of cohort and cross-cultural studies; and 4) criteria for and development of full-scale nutrition and physical activity intervention trials.

Dietary reference intakes (DRI), like its predecessor, the recommended dietary allowances (RDA) and the Recommended Nutrient Intakes (RNIs), are reference values, based on the best scientific evidence available. They serve as reference amounts of specific nutrients and food components for use in assessing the adequacy of and in planning for nutritious diets. They have been used for over 50 y as the basis for national nutrition monitoring and intervention programs in the United States, Canada, and other countries and as the basis for dietary guidance developed for both individuals and for targeted groups of people. Thus, although not developed for specific policy applications, they have represented the best scientific perspectives regarding what should be the basis for nutrition and public health policy related to foods and supplements. In determining DRIs, as was the case with the RDA, significant attention must be paid to the form of the nutrient or food component that is evaluated. Research conducted to determine how much of a nutrient is needed must evaluate the chemical form provided, the matrix in which it is given and the effect of other food components on absorption and/or utilization. Because the DRI recommendations will be used in population-wide policy development, assumptions must be made explicitly about what is expected for all of these factors in a typical diet. At the same time, where data exist relative to nontypical but potentially very significant effects on bioavailability, these must also be delineated to be of use in a variety of settings. Finally, one of the most important aspects of determining bioavailability in developing reference intakes is that as new information emerges, new complexities enter into the process. As more chemical complexes of nutrients and food components become available in the marketplace, new bioavailability factors may need to be established. Examples of such changes exist in the DRI reports already published for vitamin B-12 and folate and in previous RDA for iron and protein. It is often the different assumptions related to bioavailability that alter the reference intakes used as the basis for public health policy in different countries, rather than the basic science from which the recommendation is derived.

Resting metabolic rate (RMR) usually is measured by indirect calorimetry for a brief interval, and the results are then extrapolated to 24-hr resting energy production. The aim of the current study was to examine the validity of this approach by measuring the within- and between-day variability in RMR. The RMR was measured hourly in 14 healthy adults from 8:00 am to 4:00 pm after an overnight fast on two separate days. The results indicated that, during day 1, RMR remained unchanged from early morning to late afternoon, and there was no significant difference between RMR measurements 1 through 8. Based upon analysis of variance and intraclass correlation coefficients, the averages of the first and the last three RMR measurements were found to be unreliable. RMR reliability was improved by averaging all measurements taken during the day, and maximum reliability was obtained by averaging the middle three RMR measurements. A similar pattern of results was observed during day 2, although the overall trend was for the reliability of RMR measurements to improve relative to day 1. The average RMRs on days 1 and 2 were not significantly different. These results indicate that the current practice of establishing a patient's RMR based upon a single measurement potentially can lead to large errors in determining energy needs. Measurement reliability can be improved by serially measuring RMR, eliminating the initial measurement, and averaging the remaining two to three values.