Establishing new principles for nutrient reference values (NRVs) for food labeling purposes

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)

EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2013. Scientific Opinion on the substantiation of a health claim related to increasing maternal folate status by supplemental folate intake and reduced risk of neural tube defects pursuant to Article 14 of Regulation (EC) No 1924/2006

Following an application from Rank Nutrition Ltd, submitted for authorisation of a health claim pursuant to Article 14 of Regulation (EC) No 1924/2006 via the Competent Authority of the United Kingdom, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim related to increasing maternal folate status by supplemental folate intake and reduced risk of neural tube defects. The Panel considers that the food constituent, supplemental folate, which is the subject of the claim, is sufficiently characterised. Increasing maternal folate status by supplemental folate intake is a beneficial physiological effect in the context of reducing the risk of neural tube defects. In weighing the evidence, the Panel took into account that the association between low maternal folate intakes and an increased risk of neural tube defects is well established, and that a recent systematic review showed an effect of maternal folic acid intakes on the risk of neural tube defects. The Panel concludes that a cause and effect relationship has been established between increasing maternal folate status by supplemental folate intake and a reduced risk of neural tube defects

EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA); Scientific Opinion on principles for deriving and applying Dietary Reference Values

This Opinion of the EFSA Panel on Dietetic products, Nutrition, and Allergies (NDA) deals with the general principles for development and application of Dietary Reference Values (DRVs). These quantitative reference values for nutrient intakes for healthy individuals and populations are based on health criteria. Derived from DRVs, nutrients goals and recommendations take into account other criteria such as food composition or dietary habits, and may be used for assessment and planning of diets. It is proposed to derive the following DRVs: 1) Population Reference Intakes (PRI), 2) Average Requirement (AR), 3) Lower Threshold Intake (LTI), 4) Adequate Intake (AI), 5) Reference Intake ranges for macronutrients (RI). Nutrient requirements differ with age, sex and physiological condition. The Panel proposes to define the age ranges used for each nutrient on a case-by-case basis depending on the available data. For the age group < 6 months requirements are considered to be equal to the supply from breast- milk, except in those cases where this does not apply. Separate reference values will be established for pregnant and lactating women. Interpolation or extrapolation between population groups will be used in instances where no data are available for defined age and sex groups

Food Groups Associated with a Composite Measure of Probability of Adequate Intake of 11 Micronutrients in the Diets of Women in Urban Mali

The prevalence of micronutrient deficiency is high among women of reproductive age living in urban Mali. Despite this, there are little data on the dietary intake of micronutrients among women of reproductive age in Mali. This research tested the relationship between the quantity of intake of 21 possible food groups and estimated usual micronutrient (folate, vitamin B-12, calcium, riboflavin, niacin, vitamin A, iron, thiamin, vitamin B-6, vitamin C, and zinc) intakes and a composite measure of adequacy of 11 micronutrients [mean probability of adequacy (MPA)] based on the individual probability of adequacy (PA) for the 11 micronutrients. Food group and micronutrient intakes were calculated from 24-h recall data in an urban sample of Malian women. PA was lowest for folate, vitamin B-12, calcium, and riboflavin. The overall MPA for the composite measure of 11 micronutrients was 0.47 +/- 0.18. Grams of intake from the nuts/seeds, milk/yogurt, vitamin A-rich dark green leafy vegetables (DGLV), and vitamin C-rich vegetables food groups were correlated (Spearman's rho = 0.20-0.36; P 0.5, respectively. These findings can be used to further the development of indicators of dietary diversity and to improve micronutrient intakes of women of reproductive age. J. Nutr. 140: 2070S-2078S, 2010

The Forest for the Trees: A Systems Approach to Human Health Research

We explore the relationship between current research directions in human health and environmental and public health policy. Specifically, we suggest there is a link between the continuing emphasis in biomedical research on individualized, therapeutic solutions to human disease and the increased reliance on individual choice in response to environmental and/or public health threats. We suggest that continued research emphasis on these traditional approaches to the exclusion of other approaches will impede the discovery of important breakthroughs in human health research necessary to understand the emerging diseases of today. We recommend redirecting research programs to interdisciplinary and population-focused research that would support a systems approach to fully identifying the environmental factors that contribute to disease burden. Such an approach would be able to address the interactions between the social, ecological, and physical aspects of our environment and explicitly include these in the evaluation and management of health risks from environmental exposures

Conducting Science in Disasters: Recommendations from the NIEHS Working Group for Special IRB Considerations in the Review of Disaster Related Research.

Research involving human subjects after public health emergencies and disasters may pose ethical challenges. These challenges may include concerns about the vulnerability of prospective disaster research participants, increased research burden among disaster survivors approached by multiple research teams, and potentially reduced standards in the ethical review of research by institutional review boards (IRBs) due to the rush to enter the disaster field. The NIEHS Best Practices Working Group for Special IRB Considerations in the Review of Disaster Related Research was formed to identify and address ethical and regulatory challenges associated with the review of disaster research. The working group consists of a diverse collection of disaster research stakeholders across a broad spectrum of disciplines. The working group convened in July 2016 to identify recommendations that are instrumental in preparing IRBs to review protocols related to public health emergencies and disasters. The meeting included formative didactic presentations and facilitated breakout discussions using disaster-related case studies. Major thematic elements from these discussions were collected and documented into 15 working group recommendations, summarized in this article, that address topics such as IRB disaster preparedness activities, informed consent, vulnerable populations, confidentiality, participant burden, disaster research response integration and training, IRB roles/responsibilities, community engagement, and dissemination of disaster research results. https://doi.org/10.1289/EHP237

An integrated theoretical framework to enhance resource efficiency, sustainability and human health in agri-food systems

The absence of integrated decision-making across the agri-food system is arguably the single biggest obstacle to global food security and breaking through it is perhaps our biggest challenge. To date little research has been done which takes a fully integrated view to address this global challenge. Integrated decision making implies change across all parts of the diverse agri-food system, requiring an integrated assessment of all the processes involved from the ecology of the land through to nutrition and health. To address this research need, we propose a theoretical framework for integrated solutions based upon mapping of whole agri-food systems, their quantitative analysis based on enhanced life cycle assessment, the use of emergent data to catalyse viable and commercially attractive innovation and the free access of data to all stakeholders and in particular consumers as the principle engine for change. This integrated framework is conceptualised through theoretical development building from prior research. This theoretical framework involves an iterative methodology of four overlapping steps (Map, Analyse, Visualise and Share), namely the MAVS cycle. It gives a transparent advanced methodology and collaborative decision support to all stakeholders across the agri-food ecosystems. We hypothesize that this framework would provide a mechanism to break down the current barriers that prevent the integrated solutions absolutely necessary for global food security. We also theoretically position the perspective that it would break the “four walls” of information that reside within each organisation, fostering an open system that encourages a more democratized agri-food system, in which sustainability and resource efficiency are embedded

Development of a program logic model and evaluation plan for a participatory ergonomics intervention in construction

BACKGROUND: Intervention studies in participatory ergonomics (PE) are often difficult to interpret due to limited descriptions of program planning and evaluation. METHODS: In an ongoing PE program with floor layers, we developed a logic model to describe our program plan, and process and summative evaluations designed to describe the efficacy of the program. RESULTS: The logic model was a useful tool for describing the program elements and subsequent modifications. The process evaluation measured how well the program was delivered as intended, and revealed the need for program modifications. The summative evaluation provided early measures of the efficacy of the program as delivered. CONCLUSIONS: Inadequate information on program delivery may lead to erroneous conclusions about intervention efficacy due to Type III error. A logic model guided the delivery and evaluation of our intervention and provides useful information to aid interpretation of results

EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies), 2013 . Scientific opinion on Dietary Reference Values for fluoride

Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies (NDA) derived Dietary Reference Values (DRVs) for fluoride, which are provided as Adequate Intake (AI) from all sources, including non-dietary sources. Fluoride is not an essential nutrient. Therefore, no Average Requirement for the performance of essential physiological functions can be defined. Nevertheless, the Panel considered that the setting of an AI is appropriate because of the beneficial effects of dietary fluoride on prevention of dental caries. The AI is based on epidemiological studies (performed before the 1970s) showing an inverse relationship between the fluoride concentration of water and caries prevalence. As the basis for defining the AI, estimates of mean fluoride intakes of children via diet and drinking water with fluoride concentrations at which the caries preventive effect approached its maximum whilst the risk of dental fluorosis approached its minimum were chosen. Except for one confirmatory longitudinal study in US children, more recent studies were not taken into account as they did not provide information on total dietary fluoride intake, were potentially confounded by the use of fluoride-containing dental hygiene products, and did not permit a conclusion to be drawn on a dose-response relationship between fluoride intake and caries risk. The AI of fluoride from all sources (including non-dietary sources) is 0.05 mg/kg body weight per day for both children and adults, including pregnant and lactating women. For pregnant and lactating women, the AI is based on the body weight before pregnancy and lactation. Reliable and representative data on the total fluoride intake of the European population are not available

The Ambulatory Pediatric Association Fellowship in Pediatric Environmental Health: A 5-Year Assessment

Background: Evidence is mounting that environmental exposures contribute to causation of disease in children. Yet few pediatricians are trained to diagnose, treat, or prevent disease of environmental origin. Objectives: To develop a cadre of future leaders in pediatric environmental health (PEH), the Ambulatory Pediatric Association (APA) launched a new 3-year fellowship in 2001—the world’s first formal training program in PEH. Sites were established at Boston Children’s Hospital, Mount Sinai School of Medicine, George Washington University, University of Cincinnati, and University of Washington. Fellows are trained in epidemiology, biostatistics, toxicology, risk assessment, and preventive medicine. They gain clinical experience in environmental pediatrics and mentored training in clinical research, policy development, and evidence-based advocacy. Thirteen fellows have graduated. Two sites have secured follow-on federal funding to enable them to continue PEH training. Discussion: To assess objectively the program’s success in preparing fellows for leadership careers in PEH, we conducted a mailed survey in 2006 with follow-up in 2007. Conclusions: Fifteen (88%) of 17 fellows and graduates participated; program directors provided information on the remaining two. Nine graduates are pursuing full-time academic careers, and two have leadership positions in governmental and environmental organizations. Ten have published one or more first-authored papers. Seven graduates are principal investigators on federal or foundation grants. The strongest predictors of academic success are remaining affiliated with the fellowship training site and devoting <20% of fellowship time to clinical practice. Conclusion: The APA fellowship program is proving successful in preparing pediatricians for leadership careers in PEH