Milestones in DRI Development: What Does the Future Hold?

• Published in: Advances in nutrition (Bethesda, Md.) Vol. 10; no. 3; pp. 537 - 545
• Main Authors: Yaktine, Ann L, Ross, A Catharine
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2019; Oxford University Press
• Subjects: chronic disease; Chronic Disease - prevention & control; Diet - standards; dietary reference intakes; Forecasting; History, 20th Century; History, 21st Century; Humans; obesity; Population Health; public health; recommended dietary allowance; Recommended Dietary Allowances - trends; Reference Values; Review from ASN Annual Meeting Symposia; United States; United States; CVD; chronic disease; RCTs; T2D; UL; recommended dietary allowance; AI; dietary reference intakes; obesity; public health; CHD
• ISSN: 2161-8313; 2156-5376
• DOI: 10.1093/advances/nmy121

The state of nutritional health in the United States in the early part of the twentieth century was very different from today. Nutrient deficiencies and dental caries were prevalent health concerns for many Americans. In 1940, the US National Defense Advisory Commission asked the National Academy of Sciences for help in studying problems of nutrition in the United States. The outcome was issuance of the first RDAs. The goal of the RDAs was to recommend “…allowances sufficiently liberal to be suitable for maintenance of good nutritional status.” In the subsequent decades, a very different nutritional health challenge began to emerge for an increasing proportion of the population, that of overweight and obesity and risk of diet-related chronic disease. In part, as a response to this challenge, the RDA process was revised and the Dietary Reference Intakes (DRIs) were developed. The DRIs are a set of reference values that, when adhered to, predict a low probability of nutrient inadequacy or excessive intake. Recently, new DRI guidelines were proposed to define reference points for nutrient and food component intakes that influence risk of chronic disease. Developing DRIs for chronic disease endpoints presents unique challenges, notably, chronic diseases are multifactorial in nature and not directly nutrient-specific; the body of evidence supporting nutrients and other food substances as modifiers of risk of chronic disease is generally limited; and there is a lack of consistency in findings across study types. In addition, the latency of dietary exposures and chronic disease outcomes makes it difficult to demonstrate causality. Adapting the DRI model to meet the needs of the general population in the current context suggests a need to redefine the boundaries that describe the health of the population and to re-examine how indicators of chronic disease can be integrated effectively into the DRI process.