European micronutrient recommendations aligned: a general framework developed by EURRECA

Background: In Europe, micronutrient recommendations have been established by (inter)national committees of experts and are used by public health-policy decision makers to monitor and assess the adequacy of the diets of population groups. Current micronutrient recommendations are, however, heterogeneous, whereas the scientific basis for this is not obvious. Alignment of setting micronutrient recommendations is necessary to improve the transparency of the process, the objectivity and reliability of recommendations that are derived by diverse regional and (inter)national bodies. Objective: This call for alignment of micronutrient recommendations is a direct result of the current sociopolitical climate in Europe and uncovers the need for an institutional architecture. There is a need for evidence-based policy making, transparent decision making, stakeholder involvement and alignment of policies across Europe. Results: In this paper, we propose a General Framework that describes the process leading from assessing nutritional requirements to policy applications, based on evidence from science, stakeholder interests and the sociopolitical context. The framework envisions the derivation of nutrient recommendations as scientific methodology, embedded in a policy-making process that also includes consumer issues, and acknowledges the influences of the wider sociopolitical context by distinguishing the principal components of the framework: (a) defining the nutrient requirements for health, (b) setting nutrient recommendations, (c) policy options and (d) policy applications. Conclusion: The General Framework can serve as a basis for a systematic and transparent approach to the development and review of micronutrient requirements in Europe, as well as the decision making of scientific advisory bodies, policy makers and stakeholders involved in this process of assessing, developing and translating these recommendations into public health nutrition policy. European Journal of Clinical Nutrition (201 0) 64, S2-510; doi:10.1038/ejcn.2010.5

Prioritizing micronutrients for the purpose of reviewing their requirements: a protocol developed by EURRECA

Background: The EURRECA (EURopean micronutrient RECommendations Aligned) Network of Excellence (http://www.eurreca.org) is working towards the development of aligned recommendations. A protocol was required to assign resources to those micronutrients for which recommendations are most in need of alignment. Methods: Three important 'a priori' criteria were the basis for ranking micronutrients: (A) the amount of new scientific evidence, particularly from randomized controlled trials; (B) the public health relevance of micronutrients; (C) variations in current micronutrient recommendations. A total of 28 micronutrients were included in the protocol, which was initially undertaken centrally by one person for each of the different population groups defined in EURRECA: infants, children and adolescents, adults, elderly, pregnant and lactating women, and low income and immigrant populations. The results were then reviewed and refined by EURRECA's population group experts. The rankings of the different population groups were combined to give an overall average ranking of micronutrients. Results: The 10 highest ranked micronutrients were vitamin D, iron, folate, vitamin B12, zinc, calcium, vitamin C, selenium, iodine and copper. Conclusions: Micronutrient recommendations should be regularly updated to reflect new scientific nutrition and public health evidence. The strategy of priority setting described in this paper will be a helpful procedure for policy makers and scientific advisory bodies. European Journal of Clinical Nutrition (2010) 64, S19-530; doi:10.1038/ejcn.2010.5

EURRECA-Evidence-Based Methodology for Deriving Micronutrient Recommendations

The EURopean micronutrient RECommendations Aligned (EURRECA) Network of Excellence explored the process of setting micronutrient recommendations to address the variance in recommendations across Europe. Work centered upon the transparent assessment of nutritional requirements via a series of systematic literature reviews and meta-analyses. In addition, the necessity of assessing nutritional requirements and the policy context of setting micronutrient recommendations was investigated. Findings have been presented in a framework that covers nine activities clustered into four stages: stage one Defining the problem describes Activities 1 and 2: Identifying the nutrition-related health problem and Defining the process; stage two Monitoring and evaluating describes Activities 3 and 7: Establishing appropriate methods, and Nutrient intake and status of population groups; stage three Deriving dietary reference values describes Activities 4, 5, and 6: Collating sources of evidence, Appraisal of the evidence, and Integrating the evidence; stage four Using dietary reference values in policy making describes Activities 8 and 9: Identifying policy options, and Evaluating policy implementation. These activities provide guidance on how to resolve various issues when deriving micronutrient requirements and address the methodological and policy decisions, which may explain the current variation in recommendations across Europe. [Supplementary materials are available for this article. Go to the publisher's online edition of Critical Reviews in Food Science and Nutrition for the following free supplemental files: Additional text, tables, and figures.]This is the peer-reviewed version of the article: Dhonukshe-Rutten Rosalie, Bouwman Jildau, Brown Kerry A., Cavelaars Adrienne E., Collings Rachel, Grammatikaki Evangelia, de Groot Lisette, Gurinović Mirjana A., Harvey Linda, Hermoso Maria, Hurst Rachel, Kremer Bas, Ngo Joy, Novaković Romana, Raats Monique M., Rollin Fanny, Serra-Majem Lluis, Souverein Olga W., Timotijević Lada, van't Veer Pieter, "EURRECA-Evidence-Based Methodology for Deriving Micronutrient Recommendations" 53, no. 10 (2013):999-1040, [https://doi.org/10.1080/10408398.2012.749209

The process of setting micronutrient recommendations: a cross-European comparison of nutrition-related scientific advisory bodies

Copyright @ The Authors 2010Objective: To examine the workings of the nutrition-related scientific advisory bodies in Europe, paying particular attention to the internal and external contexts within which they operate. Design: Desk research based on two data collection strategies: a questionnaire completed by key informants in the field of micronutrient recommendations and a case study that focused on mandatory folic acid (FA) fortification. Setting: Questionnaire-based data were collected across thirty-five European countries. The FA fortification case study was conducted in the UK, Norway, Denmark, Germany, Spain, Czech Republic and Hungary. Results: Varied bodies are responsible for setting micronutrient recommendations, each with different statutory and legal models of operation. Transparency is highest where there are standing scientific advisory committees (SAC). Where the standing SAC is created, the range of expertise and the terms of reference for the SAC are determined by the government. Where there is no dedicated SAC, the impetus for the development of micronutrient recommendations and the associated policies comes from interested specialists in the area. This is typically linked with an ad hoc selection of a problem area to consider, lack of openness and transparency in the decisions and over-reliance on international recommendations. Conclusions: Even when there is consensus about the science behind micronutrient recommendations, there is a range of other influences that will affect decisions about the policy approaches to nutrition-related public health. This indicates the need to document the evidence that is drawn upon in the decisions about nutrition policy related to micronutrient intake.This work has been carried out within the EURRECA Network of Excellence (www.eurreca.org) which is financially supported by the Commission of the European Communities, specific Research, Technology and Development (RTD) Programme Quality of Life and Management of Living Resources, within the Sixth Framework Programme, contract no. 036196

Physiological and public health basis for assessing micronutrient requirements in children and adolescents. The EURRECA network

This paper provides an overview of the current knowledge relating to the nutritional requirements and corresponding recommended nutrient intake values of children and adolescents for micronutrients and specificities related to these requirements in the course of childhood and adolescence in Europe. Aspects that can influence micronutrient requirements, such as physiological requirements and bioavailability of the nutrients in the organism, are discussed. The methodology used to obtain the data and also the main knowledge gaps regarding these concepts are emphasized. Methodological critical points in achieving the data and physiological aspects of children and adolescents are important in order to standardize the reference values for micronutrients among Europe for these stages of life

Explaining the variability in recommended intakes of folate, vitamin B12, iron and zinc for adults and elderly people

Objective To signal key issues for harmonising approaches for establishing micronutrient recommendations by explaining observed variation in recommended intakes of folate, vitamin B12, Fe and Zn for adults and elderly people. Design We explored differences in recommended intakes of folate, vitamin B12, Fe and Zn for adults between nine reports on micronutrient recommendations. Approaches used for setting recommendations were compared as well as eminence-based decisions regarding the selection of health indicators indicating adequacy of intakes and the consulted evidence base. Results In nearly all reports, recommendations were based on the average nutrient requirement. Variation in recommended folate intakes (200–400 µg/d) was related to differences in the consulted evidence base, whereas variation in vitamin B12 recommendations (1·4–3·0 µg/d) was due to the selection of different CV (10–20 %) and health indicators (maintenance of haematological status or basal losses). Variation in recommended Fe intakes (men 8–10 mg/d, premenopausal women 14·8–19·6 mg/d, postmenopausal women 7·5–10·0 mg/d) was explained by different assumed reference weights and bioavailability factors (10–18 %). Variation in Zn recommendations (men 7–14 mg/d, women 4·9–9·0 mg/d) was also explained by different bioavailability factors (24–48 %) as well as differences in the consulted evidence base. Conclusions For the harmonisation of approaches for setting recommended intakes of folate, vitamin B12, Fe and Zn across European countries, standardised methods are needed to (i) select health indicators and define adequate biomarker concentrations, (ii) make assumptions about inter-individual variation in requirements, (iii) derive bioavailability factors and (iv) collate, select, interpret and integrate evidence on requirements

Approaches for setting micronutrient recommendations : a case study of vitamin B12 for adults and elderly people

Background: Most countries in Europe provide recommendations on the micronutrient composition of diets to fulfil requirements of nearly all individuals in the general apparently healthy population. However as each country uses its own methods for deriving such recommendations, there is large variation between countries in the recommended micronutrient intakes. The objectives of this thesis are to signal key issues for harmonizing approaches for establishing micronutrient recommendations for adults and elderly across Europe and to illustrate standardized and transparent review methods that can be used to summarize and evaluate the evidence-base for setting recommendations, using vitamin B12 as a case micronutrient. Methods: First the need for harmonization is substantiated by a descriptive study on the variation in published micronutrient recommendations across Europe. In addition methodological factors were identified that should be considered for alignment of recommended intakes across Europe. Secondly, the evidence-base for establishing recommended vitamin B12 intakes was summarized in two systematic reviews. One review focused on requirements for the compensation of daily obligatory losses (factorial approach) and the other review evaluated the relation of vitamin B12 intake and status with cognitive performance (dose-response approach). Whether interactions between folate and vitamin B12 on cognitive performance should be considered for establishing recommended vitamin B12 intakes was evaluated using data from 2203 Norwegian elderly from the Hordaland Homocysteine Study. Results: For harmonizing approaches for establishing micronutrient recommendations, standard methods are needed to a)-select health indicators and define adequate biomarker concentrations, b)-make assumptions about inter-individual variation in requirements, c)-derive bioavailability factors, and d)-select and interpret evidence on requirements. The first systematic review showed that daily vitamin B12 losses in apparently healthy adults and elderly probably range between 2.6-3.9 µg and bioavailability from the usual diet may range between 29 and 37% rather than the generally assumed 50%. Dose-response evidence from 2 randomized controlled trials and 19 prospective cohort studies showed no or inconsistent associations between vitamin B12 intake or status and dementia, Alzheimer’s Disease, global cognitive function or domain-specific cognitive function in adults and elderly people. Cross-sectional analyses in the Norwegian cohort study showed that low plasma vitamin B12 in combination with high folate was associated with better cognitive performance. However, these associations were not observed for sensitive markers of vitamin B12 status. Conclusion: The main conclusion of this thesis is that evidence underlying current recommended vitamin B12 intakes is old and has large uncertainties, whereas the available evidence on the relation between vitamin B12 and cognitive performance is yet not convincing and thereby limits its use as an outcome for estimating vitamin B12 requirements. The relation between vitamin B12 intake and markers of vitamin B12 status seems the best alternative, but sound statistical methods to define recommendations based on these dose-response data should be further developed. </p