The Health Value of Modelled Healthy Eating Patterns Is Largely Constrained by the Current Reference Values for Bioavailable Iron and Zinc

Objectives We aimed to study if, and to what extent, the current nutrient reference values for bioavailable iron and zinc limit the identification of healthier dietary patterns. Methods Using observed diets from a representative French survey (INCA3) and multi-criteria optimization, we identified diets that comply with all nutrient reference values and maximize a health criteria based on food-based dietary guidelines while minimally departing from the observed diet. Nutrient reference values included absorbed iron and zinc. This non-linear diet optimization problem was solved in men and women with higher (Fe−) and lower (Fe+) iron requirements separately, either strictly (Non Flexible model, NF) or by allowing some tolerance on absorbed iron and zinc using goal programming to minimize their decreases below reference values (Flexible Model, F). Using a comparative risk assessment framework and a probabilistic approach, we estimated changes in risks of cardiovascular diseases, diabetes and colorectal cancer, and changes in estimates of the prevalence of iron-deficiency anemia for the diets optimized using each model. Results With the NF model, the reference values for absorbed iron and zinc were the most binding constraints (over 34 constraints). Compared to the observed diets, the NF-optimized diets showed large redistributions within cereals and meats, with total meat consumption remaining similar in men and Fe- women and doubling in Fe + women. In contrast, the F-optimized diets had higher value for the health criteria objective, being systematically lower in meat, especially red meat, and higher in whole grain products. We estimated that the reduction in mortality risk would be 17.7% wih the NF-optimized diets and 21.5% with the F-optimized diets. However, the later diets would increase the prevalence of iron-deficiency anemia from 2.1% currently to 5.6%. Conclusions We evidenced that the reference values for iron and zinc with regard to their bioavailability are critical factors when modelling healthy eating patterns. Considering lower references for iron and zinc leads to identify diets with an apparent higher benefit for the population health with regards long-term health. Funding Sources None.

Complementary Feeding in the Preterm Infants: Summary of Available Macronutrient Intakes and Requirements

Limited data are available regarding the nutritional needs for preterm infants. In most cases, guidelines refer to the acquisition of neuromotor skills, adequate weight and corrected chronological age. While waiting for the establishment of specific nutritional indications for premature infants we proposed the weaning recommendations for term infants of the Italian Society of Human Nutrition with LARNs (Reference intake Levels of Nutrients and energy for the Italian population) of 2014, the Dietary Reference Values for nutrients of European Food Safety Authority (EFSA) of 2017 and the Nutrient Reference Values for Australia and New Zealand Including Recommended Dietary Intakes of 2017.

Protocol for meta-research on the evidence informing micronutrient dietary reference intakes for pregnant and lactating women

Nutrient reference values are important parameters that guide nutrition and public health work globally. Micronutrient requirements during the peri-conception period are generally increased, which is essential in ensuring maternal, fetal, and neonatal health. Nevertheless, the current dietary reference intakes (DRIs) may be limited in terms of the methods used and the populations included, particularly the DRIs for pregnancy and lactation. In this proposed review, we will examine the methods (rigor of design, utilization of molecular methods, and presence of modern methods) and the population (inclusion of women, and in particular, pregnant and lactating people) in the studies used to inform the current DRIs. We will apply meta-science methods to this review, which involves formally reviewing the current evidence, and identifying opportunities to improve how we fund, perform, evaluate, and incorporate nutrition science into public health programs for better outcomes.

An Analysis of the Mineral Composition of Pink Salt Available in Australia

Little is known about the mineral composition of pink salt. The aim of this study was to evaluate for the first time the mineral composition of pink salt available for purchase in Australia and its implications for public health. Pink salt samples were purchased from retail outlets in two metropolitan Australian cities and one regional town. Color intensity, salt form, and country of origin were coded. A mass spectrometry scan in solids was used to determine the amount of 25 nutrients and non-nutritive minerals in pink salt (n = 31) and an iodized white table salt control (n = 1). A wide variation in the type and range of nutrients and non-nutritive minerals across pink salt samples were observed. One pink salt sample contained a level of lead (>2 mg/kg) that exceeded the national maximum contaminant level set by Food Standards Australia New Zealand. Pink salt in flake form, pink salt originating from the Himalayas, and darker colored pink salt were generally found to contain higher levels of minerals (p < 0.05). Despite pink salt containing nutrients, >30 g per day (approximately 6 teaspoons) would be required to make any meaningful contribution to nutrient intake, a level that would provide excessive sodium and potential harmful effects. The risk to public health from potentially harmful non-nutritive minerals should be addressed by Australian food regulations. Pink salt consumption should not exceed the nutrient reference values for Australia and New Zealand guidelines of <5 g of salt per day.

Why the Derivation of Nutrient Reference Values Should be Harmonized and How It Can be Accomplished

ABSTRACT The adoption of a panel of Nutrient Reference Values (NRVs) in place of a single recommended intake allowed for assessment of nutritional adequacy and safe upper intake levels for nutrients on a population level and for individuals. The Average Requirement (AR) and Tolerable Upper Intake Level (UL) comprise 2 core NRVs needed to obtain accurate, comparable estimates of population-level nutrient intakes, which are necessary to plan and evaluate nutrition support programs globally. Harmonizing the derivation of NRVs, particularly the AR and UL, is essential to ensure inclusion of all countries, whether high-, middle-, or low-income, in the process and to improve access for all users to the tools and data needed to carry it out. The NRV process today is more rigorous and transparent than the first derivation of DRIs because of adoption of systematic reviews and bias assessment methodologies, updated food and nutrient databases, data on cultural and context-specific dietary patterns, and better metabolic markers of nutritional status. A proposed framework for the derivation of NRVs builds on available methodologies to support the NRV process; however, this is not sufficient to achieve harmonization of the process. Fundamental to moving forward toward harmonization is removing existing barriers, including limited access to resources and databases and variance in terminology used to identify specific NRVs; adoption of more rigorous and transparent methodologies, including chronic disease endpoints, in the review process; and creating a central repository for easily accessible evidence. Chief among the barriers to harmonization is a willingness of global bodies to support an agreed-upon approach to the derivation process. Improving access to tools and data resources and providing guidance and support to encourage their adoption are critical to achieving harmonization of the NRV process. The factorial approach for calculating a nutrient requirement is described as the sum of total endogenous nutrient loss (endogenous fecal, urinary, integumental, seminal, menstrual) divided by its bioavailability or fractional absorption.

Harmonizing Micronutrient Intake Reference Ranges for Dietary Guidance and Menu Planning in Complementary Feeding

ABSTRACT There are no published harmonized nutrient reference values for the complementary feeding period. The aim of the study was to develop proposals on adequate and safe intake ranges of micronutrients that can be applied to dietary guidance and menu planning. Dietary intake surveys from 6 populous countries were selected as pertinent to the study and reviewed for data on micronutrients. The most frequently underconsumed micronutrients were identified as iron, zinc, calcium, magnesium, phosphorus, potassium, and vitamins A, B6, B12, C, D, E, and folate. Key published reference values for these micronutrients were identified, compared, and reconciled. WHO/FAO values were generally identified as initial nutrient targets and reconciled with nutrient reference values from the Institute of Medicine and the European Food Standards Authority. A final set of harmonized reference nutrient intake ranges for the complementary feeding period is proposed.