David M. Klurfeld Agricultural Research Service Beltsville, MD

Disclaimers The views presented here are those of the speaker and do not necessarily reflect official positions of the USDA or the Agricultural Research Service I am a member of the Federal DRI Steering Committee U.S. USDA, DHHS, DOD Canada Health Canada, Canadian Institutes of Health Research

Dietary Reference Intakes Developed in 1941, published at ~10-year intervals Recommended Dietary Allowances in U.S. Recommended Nutrient Intakes in Canada Series of 7 volumes published 1997-2002 Concept broadened from preventing deficiencies to also preventing chronic disease Includes upper limits of intake Intended to highlight concepts of probability and risk for defining reference values Currently includes only essential nutrients

Dietary Reference Intakes Estimated Average Requirement (EAR) Level of intake for which the risk of inadequacy is 50% Recommended Dietary Allowance 2 SD above EAR Adequate Intake (AI) Set when EAR cannot be established Usually due to lack of dose-response data Set for at least 12 nutrients Chronic disease endpoint used for few nutrients, all with AI Fiber, Fluoride, Potassium, AMDRs, Sodium, Chloride

Dietary Reference Intakes Volume on Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids 1331 pages, published 2002/2005 120 pages on Dietary Fats: Total Fat and Fatty Acids Linoleic acid (18:2) is the only essential n-6 AI 17 g/d for men; 12 g/d for women Alpha-Linolenic acid (18:3 n-3) The AI can provide the beneficial health effects associated with the consumption of n-3 fatty acids.

Omega-3 Fatty Acid Recommendations Acceptable Intake 0.5 g/day of n-3 for infants 1.6 g/day of ALA for men ~0.6% En 1.1 g/day of ALA for women Based on median intake of ALA in CSFII where signs of deficiency were nonexistent EPA and DHA can contribute 10% to the AI for ALA based on estimated intake Source: Dietary References Intakes, IOM, 2002/2005

G. Danaei et al, PLoS Medicine, 6(4): e1000058 (2009)

Omega-3 s Prevent/Treat/Cure: Heart disease Hypertriglyceridemia Hypertension Fast/slow heart rate Arrhythmia Depression Criminal behavior Diabetes Arthritis Macular degeneration Cancer Clotting disorders Inflammation Cognitive decline Alzheimer s disease Premature delivery ADHD Autism Allergies Yada, yada, yada

What Constitutes Evidence? The authors should please note that in dietary epidemiology, prospective cohort studies are regarded virtually on a par with RCTs. This could be better emphasized. Epidemiologist referee on systematic review paper In terms of prevention, you should discount all claims about effects discovered in observational studies. Consider them hypotheses to be evaluated. J. Michael Oakes, U Minn, IOM Workshop, Jan 8, 2009

DRI Research Synthesis Workshop held at IOM June 7-8, 2006 It probably is important to revisit DRIs for fatty acids, particularly for n-3 fatty acids, to consider health promotion rather than deficiency symptoms. Also, considerable research published since 2002 concerning docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) merits consideration with regard to setting DRI values for these two fatty acids. Page 76 from Workshop Summary book, 2007

Are EPA & DHA Essential? Conversion from ALA ranges from 1% to 10% Higher at low n-6/n-3 ratio of 2:1 Typical U.S. ratio of 10:1, conversion ~1% Many people consume no preformed EPA or DHA from fish/marine products Efficient recycling of essential fatty acids in absence of intake So there are no data demonstrating classical nutritional deficiency

Dietary Guidelines for Americans 2010 DGA recommend 8 ounces/week of a variety of seafood, which provide and average consumption of 250 mg/day of EPA and DHA, associated with reduce cardiac deaths among individuals with and without pre-existing cardiovascular disease The recommendation is to consume seafood for the total package of benefits that seafood provides, including its EPA and DHA content.

IFIC Foundation Food & Health Survey, 2011

As of March 12, 2012 PubMed search for omega 3 fatty acids or n-3 fatty acids 16,644 papers & human 6891 papers 3,016 reviews & human 2245 papers & clinical trial 982 papers

What s Next for DRIs??? Currently evaluating positives and negatives from process for vitamin D/calcium report (2011) Establishing process for prioritizing nutrients to be reviewed Federal DRI Steering Committee decides DRIs for prevention of deficiency or primary prevention of a chronic disease in the general population secondary prevention studies not used Is there a biomarker that can be measured? Are there RCTs? Or are all the data observational?

And a piece of algae for Omega-3.