The New Australian and New Zealand Nutrient Reference Values

Size: px

Start display at page:

Download "The New Australian and New Zealand Nutrient Reference Values"

Christal Barton
5 years ago
Views:

The New Australian and New Zealand Nutrient Reference Values Colin Binns Mi Kyung Lee Curtin University May 2004 Australia 19 million people, including about 400,000 Indigenous persons (2% of total)

1 The New Australian and New Zealand Nutrient Reference Values Colin Binns Mi Kyung Lee Curtin University May 2004 Australia 19 million people, including about 400,000 Indigenous persons (2% of total) 50,000 years of Aboriginal settlement, 216 years of European settlement 6th largest land mass in world, almost same as USA (excluding Alaska) Lowest population density among developed countries - 2 persons per sq km Climate varied but mainly continental and dry Highly urbanised, most people living in south-east seaboard region (around the coast in 6 cities) Life expectancy - 81 years for women, 76 for men Fertility rate below replacement level (1.7)

2 Percentage of Population Born in Asia Country Australia USA Canada UK France Italy New Zealand Sweden Percentage Australian social trends / Australian Bureau of Statistics, 2001, Canberra : Australian Bureau of Statistics ISSN: Where Australians Live One of the most urbanised countries in the world particularly older Australians.

4 Curtin University

5 Curtin University 30,000 students 5,000 International students on campus (>100 countries) Another 4,000 at overseas campuses

History The first Australian RDA s were published in 1954, based on the US RDA s. Revisions to the RDA s were published in 1961, 1971, 1979, 1984, 1987 and 1991.

6 History The first Australian RDA s were published in 1954, based on the US RDA s. Revisions to the RDA s were published in 1961, 1971, 1979, 1984, 1987 and Up until 1991 the RDA s were based on USA or FAO documents. The RDI s 1991 (Name change) were developed independently from the original publications, took more than 10years. The RDI s were adopted by New Zealand. Need for revision given developments in Europe and USA. - joint Australian/New Zealand review. Agreement was reached that a review would go ahead with NZ paying about one tenth the costs and Australia nine-tenths in accord with population numbers.

The Use of RDI s (1991 introduction) The recommended dietary intakes may be used: as a guide to planning menus for individuals and groups; for a first assessment of the adequacy of the diet of a

7 The Use of RDI s (1991 introduction) The recommended dietary intakes may be used: as a guide to planning menus for individuals and groups; for a first assessment of the adequacy of the diet of a group or individual (the use in this respect is limited because of the wide 'margin for safety' incorporated into values allowed for some nutrients, variations in the needs of individuals, and the need to consider social factors); as the denominator for nutrition labelling;

8 The Use of RDI s (1991 introduction) as the reference for monitoring availability of nutrients in the national food supply; and as a guide in planning diets for specific therapeutic purposes (although the tables are designed for normal healthy people). (NHMRC 1991) The RDI s were adopted by FSANZ (and its predecessors) for use in the regulation of fortification and food labelling in Australia. Fortification levels for a specific food are expressed as a x% of the RDI per standard serving size. Public Health Nutrition Uses: Core food groups Australian Guide to Health Eating Australian Dietary Guidelines: Adults Older Australians Children and Adolescents Infant Feeding Guidelines

Australian Guide to Health Eating Food Plate: Segments represent food groups in the Dietary Guidelines Different Plates for different ethnic groups Dietary Guidelines in Australia Adults (18+ years)

9 Australian Guide to Health Eating Food Plate: Segments represent food groups in the Dietary Guidelines Different Plates for different ethnic groups Dietary Guidelines in Australia Adults (18+ years) Children & Adolescents (0-18 years) Older Australians (65+ years) Infant Feeding Guidelines Australian Guide to Healthy Eating: National Nutrition Education tool then go to publications & nutrition

10 Dietary Guidelines for Australians. Publications Nutrition Publications Nutrition

11 The Revision Name change from RDI to Nutrient Reference Values Nutrient rather than Dietary because of the intake of supplements etc. Terms of Reference 1. Oversee the review of the 1991 RDIs; 2. Ensure that the recommendations are based on best available scientific evidence; 3. Consider US/Canada DRVs, taking into account any unique aspects of Australia and New Zealand. 4. Consider new scientific evidence and other reviews- UK, the European Union countries or FAO/WHO; 5. Follow processes and standards acceptable to the Aust DHA, NZ MOH, NHMRC, SIGNAL; and 6. Report to Aust DHA, NZ MOH, NHMRC, SIGNAL National Health and Medical Research Council

12 The present Australian New Zealand review is based mainly on the USA-Canada documents. But we may also use other documents: UK Europe Germany Japan Need for change: Examples of differences with USA

13 Example of variation between USA and Australia: Vit B 6 Vitamin B-6 mg/day Fig 1: B6-RDA comparison Australia (1991) v. USA/CAN 2000 AUS1991 USA/CAN2000 Infant 0/6m Infant7/12m Child 1 Child 3 Child 4 Child 8 Boys 9 Boys 13 Boys 14 Boys 18 Girls 9 Girls 13 Girls 14 Girls 18 Men 19 Men 50 Men 51 Men 70+ Women 19 Women 50 Women 51 Women 70+ Pregnancy 14 Pregnancy Lactation 14 Lactation 50 Nutrient VITAMINS Australia &NZ 1991 (RDI) 19-64yrs US/Canada 2001/2002 (DRI) RDA (*AI) UK (DRV) FAO/WHO (RNI) 2002 EU SCF (PRI) 1993 Thiamin F M Riboflavin F M Niacin F M Vit B6 F M / / /3/ / Pantothenate M - 5* 5* * 3-12* Biotin Folic F M F M * 30* * * *

14 RESPONSIBILITY for NRV s Commonwealth Dept of Health & Ageing Ministry of Health NZ NHMRC COUNCIL Health Advisory Committee NRV Working Party Working Groups (eg minerals) Reviewers Reviewers Reviewers

15 The scope of the NRV revision: More nutrients (42) than the previous RDI s Macronutrients other than energy and protein now included with an Acceptable Macronutrient Distribution Range estimated for macronutrients Several values per nutrient Need for evidence-based approach An evidence-based approach Time, budget - not possible for Australia to do a full, formal evidence-based assessment of all the literature for each of the nutrients. But we still need a formal evidence assessment. (legislation). The US/Canadian DRI s, developed by a process of expert consensus. Australia attempting a formal evidence-based approach wherever possible. Benefit of time (new studies) and commentaries on DRV s. Use the NHMRC description of levels of evidence to assess US/Canadian DRI reviews and in framing a response to these in terms of adoption in Australia/New Zealand

16 NHMRC s Level of Evidence : I Evidence obtained from a systematic review of all relevant randomised controlled trials. II Evidence obtained from at least one properly-designed randomised controlled trial. III-1 Evidence obtained from well-designed pseudo-randomised controlled trials (alternate allocation or some other method). III-2 Evidence obtained from comparative studies (including systematic reviews of such studies) with concurrent controls and allocation not randomised, cohort studies, case-control studies, or interrupted time series with a control group. III-3 Evidence obtained from comparative studies with historical control, two or more single arm studies, or interrupted time series without a parallel control group. IV Evidence obtained from case series, either post-test or pretest/post-test. Source: A Guide to the Development, Implementation and Evaluation of Clinical Practice Guidelines NHMRC Quality assessment checklist items coding Items on the quality assessment checklist are coded according to the extent to which the criteria are fulfilled, using the coding described by Liddle et al These codes are descriptive aids, and not a quality scoring system.

17 Codes for overall assessment of quality of study checklists Low risk of bias A All or most evaluation criteria from the checklist are fulfilled. Low moderate risk of bias B1 Some evaluation criteria from the checklist are fulfilled. Where evaluation criteria are not fulfilled or are not adequately described, the conclusions of the study or review are thought unlikely to alter. Moderate high risk of bias B2 Some evaluation criteria from the checklist are fulfilled. Where evaluation criteria are not fulfilled or are not adequately described, the conclusions of the study or review are thought likely to alter.. High risk of bias C Few or no evaluation criteria fulfilled. Where evaluation criteria are not fulfilled or are not adequately described, the conclusions of the study or review are thought very likely to alter. Unable to ascertain bias D Narrative review reporting results from numerous studies.

18 Factors which may change RDI s (NRV s) from country to country include the following: Food culture: e.g. religious food beliefs, food taboos for different physiological states such as pregnancy and lactation. Socioeconomic factors. Disease patterns, parasitism, malnutrition and degenerative diseases. Physical activity levels. Age distribution. Health objectives of the national policy. Current nutrient intakes There may be less variation between countries than within population of the country. Fortification level with respect to bioavailability. Environmental conditions: a. Sunlight (differences with US and between Australian states such as Queensland and Tasmania) b. Soil composition c. Ambient temperatures

19 Additional specific needs, and for Australia and New Zealand these include: a.aboriginal population in Australia: Aboriginal and Torres Strait Islanders b.polynesian population of New Zealand: Maori & Pacific Peoples. c.other ethnic groups (eg BMI differences between Caucasians and Asians) d. Differences in body weight and bone density (e.g. in NZ Tongans have a higher BMI and bone density; for Aboriginal people, a lower BMI is probably optimal) e. Traditional diets of Maori People. Dietary fibre intake: the intake of Australians and New Zealanders is higher than in the UK and US.

20 Difference between body fat content between Asian and Caucasians. BMI levels for obesity in Asia The levels of BMI with the same proportion of fat as a Caucasian with a BMI of 30 are: Caucasian 30 Chinese 27.5 Malay 27 Indian 26 Deurenberg-Yap M, Deurenberg P. Paradox of low BMI and high body fat percentage among Singaporeans,. Int J Obesity 2000;24:

21 REVIEW PROCESS: Instructions given to reviewers For the nutrient you are reviewing, please indicate your assessment of the US/Canadian review document and recommendations with respect to its suitability as the basis for adoption in Australia/New Zealand by answering the following questions. 1. In your opinion, is this an accurate summary of the literature at this time? YES NO (circle one) If NO, what are your concerns (check as many as are relevant) Missing key publications available at the time of the review New or emerging data not available at the time of review Interpretation of cited data and publications (including issues of balance) Other issues

22 When assessing whether there are any key missing papers or new papers not included, Indicate what data bases you searched and what key words were used to identify missing papers? Please detail any references to missing/new data and data base/search terms. If your concerns are interpretational or for other concerns, please detail below How would the above concerns affect the final recommendations for Nutrient Reference Values (EAR, RDI, AI, UL, EER, AMDR)? Do these concerns apply to all population groups, or are they specific for age, gender or other grouping in Australia and/or New Zealand. 2. Was the selection of indicators for estimating requirement appropriate? YES NO (circle one) If NO, please detail your concerns What indicators do you suggest be used (give rationale) How would this affect your recommendations?

23 3. Were the recommendations by life stage and gender group justified? YES NO (circle one) If NO, please detail your concerns How would this affect your recommendations? 4. Were issues of special needs of groups taken into account where relevant? Special needs groups may include: Vegetarians, Bottle vs breast fed infants, Chronic conditions, Cultural groups, Racial groups Cigarette smokers, Oral contraceptive users, High alcohol use, Drug use, Athletes, Tropics dwellers, Other special groups If NO, please detail your concerns. How would these concerns affect the recommendations?

24 5. Was the issue of interactions with other nutrients/nonnutrients; bioavailability adequately addressed If NO, please detail your concerns What other factors need to be taken into consideration? How would this affect the recommendations? 6. Were any of the other factors that might affect requirements of this particular nutrient adequately addressed? (such as customary intakes of other competing nutrients or usual levels of other interfering or enhancing factors in the diet; particular lifestyle characteristics eg. Physical labour, prevalence of disease, overall nutritional status; marked climatic differences between study areas; SES of study populations etc) If NO, please state the other factors that should have been taken into account (give rationale) How would this affect the recommendations?

25 7. Are the differences in current intakes between the US/Canada and Australia/New Zealand so marked as to affect any of the recommendations (may be particularly relevant, by definition, to AI or AMDR recommendations) If YES, please detail how differences might affect the recommendations 8. Is the Upper Intake Level adequately addressed and is it appropriate for to Australia/New Zealand If NO, please detail your concerns How would this affect your recommendations?

26 9. Is there evidence for a chronic disease protective effect of higher than RDI levels for this nutrient? YES NO (circle one) Has this been considered in the US/Canadian document? YES NO (circle one) If the US/Canadian document does not adequately address this issue, please give details of your response (with references ) 10. Is there evidence for a chronic disease promotion effect of higher than RDI levels for this nutrient? YES NO (circle one) Has this been considered in the US/Canadian document? YES NO (circle one) If the US/Canadian document does not adequately address this issue, please give details of your response (with references)

27 11. Are there any other considerations you wish to make that would affect recommendations for Australia/New Zealand? YES NO (circle one) If yes, please state here, with justification. For key papers used in the US/Canadian review or for new/missing papers (separate tables) please complete the form below: Grading Example: Level Reference (first author and date) Buck (1996) What was the quality of the paper/review (A, B, C, D) B What was the key finding/issue addressed in the review Calcium supplementation in adolescence improves bone density

28 Final check list In assessing the adoptability of the UDS/Canadian values, have you taken into consideration the following factors: Environmental differences YES NO Geographical differences YES NO Physiological differences YES NO Ethnic factors YES NO Cultural factors YES NO UK recommendations YES NO EU recommendations YES NO FAO/WHO recommendations YES NO Summary of Assessment of suitability of US/Canadian recommendations Do you consider the recommendations for.(nutrient) in the US/Canadian DRI publication to be acceptable for adoption in Australia/New Zealand? Please check one below: Adopt without change Adopt with minor changes Adopt with substantial changes Unsuitable for adoption

29 Recommendations for Australia and New Zealand Nutrient Reference Values On the basis of your review in total, and the information given in the answers to the above questions, state your recommendations for NRVs for Australia/New Zealand. Give consideration to all relevant values (see definitions in introduction), the general population and relevant sub groups of the population. If your recommendation is #4 unsuitable for adoption, state your preferred process for reaching NRVs for Australia/NZ. Nutrient Reference Values included: EAR RDI U I L AI EER AMDR Estimated Average Requirement Recommended Dietary Intake Upper Intake Limit Adequate Intake (Where EAR and RDI not possible) Estimated Energy Requirements Acceptable Macronutrient Distribution Range

30 Today the role of the NRV s is not just to prevent nutritional deficiencies, but to assist the population to avoid harm from excessive intakes(beaton 2003). This has lead to the development of Tolerable Upper Limit. In modern societies this situation can occur from: Supplements Fortification Unbalanced diets In the future genetically modified foods may have an excess of one nutrient or another. The final priority list of Nutrients to be covered in the Australian New Zealand Review: Macronutrients Energy, Protein, Total Fat, Omega 3 fatty acids, Omega 6 fatty acids, Cholesterol, Carbohydrates (complex and simple -?do we still use these terms), Fibre, and Water.

31 The final priority list of Nutrients to be covered in the Australian New Zealand Review: Vitamins Vitamin A, Thiamin, Riboflavin, Niacin, Folate, Vitamin B6, Vitamin B12, Vitamin C, Vitamin D, Vitamin E, Vitamin K, Biotin, Choline and Pantothenic acid The final priority list of Nutrients to be covered in the Australian New Zealand Review: Minerals Arsenic, Boron, Calcium, Chromium, Copper, Fluoride, Iodine, Iron, Magnesium, Manganese, Molybdenum, Nickel, Phosphorous, Potassium, Selenium, Silicon, Sodium, Vanadium and Zinc.

32 Age groups: same as USA if possible Levels for breast-fed and formula-fed infants from 0-6 months and 7-12 months. Report values for each age group used in the US documents (1-3, 4-8, 9-13, 14-18, 19-30, 31-50, 51-70, 70+ years). Recommendations will be expressed as + additional quantity for pregnancy and lactation at all ages. Details will then be given of these amounts. Standard Weights: same as USA if possible There are some differences between Aust/NZ and the USA, but because of intra-country variation and the degree of uncertainty in the NRV process it was decided to use the USA weights.

33 Criteria for papers/studies to be considered Refereed journals: i.e. no company reports or unpublished data to be considered. Must be original data. Measured using established (standard) methodologies. Ranking of epidemiology study types (by established epidemiological criteria): Prospective studies (Trials, cohort studies) Case control studies Cross-sectional Ecological Other types of nutritional studies to be considered include: Spontaneous deficiency disease (dose required to cure). Experimental deficiency disease. Balance studies Usual intakes of healthy individuals Converging studies, especially if there is no gold standard. Biological consistency of study. For optimum levels, epidemiological studies will be needed Animal studies and case reports will be used especially for toxicological studies.

34 Other types of nutritional studies to be considered include: Bioavailability issues: body composition, absorption, and utilisation. Bioavailability needs to be considered with regard to supplements. Adaptation stores should be considered (especially for low intakes) Selection criteria for reviewers Essential Academic qualification in Human Nutrition or equivalent. Preference given to those with PhDs (or equivalent from accredited university). Previous experience writing similar papers. Preferred Demonstrated familiarity/ knowledge with relevant literature in the area of the specific nutrient. Nutrition research and publications (current or recent).

35 Progress: We have reviews on about 60% of nutrients Meeting will be held in June to 1. Finalise first batch 2. Decide on Estimated Energy Requirements and Acceptable Macronutrient Distribution Range Examples: Completed Proforma for Arsenic Final report chapter for Vit A (draft)

36 Vitamin A There has been some discussion in the literature about the conversion factors used to derive retinol equivalence for carotenoids. The US/Canadian DRI review suggested a Retinol Equivalence Activity (RAE) of 12ug for beta-carotene and 24ug for alpha-carotene and beta-cryptoxanthin. However this was based on experimental absorption studies using the less well absorbed green leafy vegetables as the predominant source of carotenoids. In Australia and New Zealand the predominant source of these carotenoids in the diet are carrots, pumpkins, sweet potato (kumara) and other root/fruiting vegetables as well as fruit. Given this, and the position taken by the FAO that the evidence base for a change at this time is insufficient (REF) in this revision we have retained the equivalence conversion factor of 6ug for beta-carotene and 12ug for alpha-carotene and betacryptoxanthin (see explanatory notes page for further discussion).we have also retained the term Retinol Equivalents rather than the new Retinol Activity Equivalents terminology used by the US/Canadian review Timetable Reviews to be completed June 2004 Writing of report Public Consultation Sept 2004 Publication 2005

37 The New Australian and New Zealand Nutrient Reference Values: A work in progress All nutrition documents are available over the Internet Follow links to Publications and Nutrition Dietary Guidelines for Australians. Publications Nutrition

40 Kamsa hamnida Thank you

Expert Consultation On Nutrient Risk Assessment For Determination Of Safe Upper Levels For Nutrients New Delhi, India, 4 December 2015

Expert Consultation On Nutrient Risk Assessment For Determination Of Safe Upper Levels For Nutrients New Delhi, India, 4 December 2015 Nutrient Risk Assessment & Upper Levels in the EU Basil Mathioudakis