title: Options for basing Dietary Reference Intakes (DRIs) on chronic disease endpoints: report from a joint US-/Canadian-sponsored working group.
abstract: Dietary Reference Intakes (DRIs) are used in Canada and the United States in planning and assessing diets of apparently healthy individuals and population groups. The approaches used to establish DRIs on the basis of classical nutrient deficiencies and/or toxicities have worked well. However, it has proved to be more challenging to base DRI values on chronic disease endpoints; deviations from the traditional framework were often required, and in some cases, DRI values were not established for intakes that affected chronic disease outcomes despite evidence that supported a relation. The increasing proportions of elderly citizens, the growing prevalence of chronic diseases, and the persistently high prevalence of overweight and obesity, which predispose to chronic disease, highlight the importance of understanding the impact of nutrition on chronic disease prevention and control. A multidisciplinary working group sponsored by the Canadian and US government DRI steering committees met from November 2014 to April 2016 to identify options for addressing key scientific challenges encountered in the use of chronic disease endpoints to establish reference values. The working group focused on 3 key questions: 1) What are the important evidentiary challenges for selecting and using chronic disease endpoints in future DRI reviews, 2) what intake-response models can future DRI committees consider when using chronic disease endpoints, and 3) what are the arguments for and against continuing to include chronic disease endpoints in future DRI reviews? This report outlines the range of options identified by the working group for answering these key questions, as well as the strengths and weaknesses of each option.
authors.affiliation: Office of Dietary Supplements, NIH, Bethesda, MD.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Yetley
authors.affiliation: Bureau of Nutritional Sciences, Health Canada, Ottawa, Ontario, Canada; amanda.macfarlane@hc-sc.gc.ca.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: MacFarlane
authors.affiliation: Bureau of Nutritional Sciences, Health Canada, Ottawa, Ontario, Canada.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Greene-Finestone
authors.affiliation: Boston College, Chestnut Hill, MA.|Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC.|Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Cutberto
authors.initials: C
authors.lastname: Garza
authors.affiliation: Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC.
authors.forename: Jamy D
authors.initials: JD
authors.lastname: Ard
authors.affiliation: Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Atkinson
authors.affiliation: Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Bier
authors.affiliation: Department of Statistics, Iowa State University, Ames, IA.
authors.forename: Alicia L
authors.initials: AL
authors.lastname: Carriquiry
authors.affiliation: Retired, Office of the Director, NIH, Bethesda, MD.
authors.forename: William R
authors.initials: WR
authors.lastname: Harlan
authors.affiliation: The George Perkins Marsh Institute, Clark University, Worcester, MA.
authors.forename: Dale
authors.initials: D
authors.lastname: Hattis
authors.affiliation: Children's Hospital Oakland Research Institute, Oakland, CA.|Department of Nutritional Sciences, University of California, Berkeley, Berkeley, CA.|Department of Nutrition, University of California, Davis, Davis, CA.
authors.forename: Janet C
authors.initials: JC
authors.lastname: King
authors.affiliation: McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Krewski
authors.affiliation: Department of Nutritional Sciences, University of Toronto.|The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: O'Connor
authors.affiliation: Fred Hutchinson Cancer Research Center.|School of Public Health, University of Washington, Seattle, WA.
authors.forename: Ross L
authors.initials: RL
authors.lastname: Prentice
authors.affiliation: Ramboll-Environ International Corporation, Arlington, VA; and.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Rodricks
authors.affiliation: Department of Epidemiology and Community Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
mesh_terms: D000368:Aged; D002170:Canada; D002908:Chronic Disease / Q000517:prevention & control; D004032:Diet; D006801:Humans; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009752:Nutritional Status; D009765:Obesity / Q000150:complications; D064167:Recommended Dietary Allowances; D012016:Reference Values; D014481:United States
keywords: Dietary Reference Intakes; chronic disease; evidence assessments; evidentiary challenges; intake response