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XNB151 Week 5 Reference standards and advice 2013


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XNB151 Week 5 Reference standards and advice 2013

  1. 1. HowDo we know what nutrients are in a particular food and how much?Do we know if an individual, group or population is eating enough of a particular food or nutrient?Can we tell an individual, group or population is eating too much of a particular food or nutrient?Can we identify if a child is not growing normally?Can we monitor trends in underweight, overweight and obesity in a population?Can we guide consumers towards food choices that are consistent with current dietary recommendations for optimising health and preventing nutrition related disease?
  2. 2. Tables of Food CompositionUsed to: Convert information about food intake to nutrient intakeContain: Nutrient data that is an average of nutrients in a particular sample of foods & ingredients, determined at a particular timeNeed to: Be current Match the food supply NOTE: The nutrient composition of foods & ingredients can vary substantially over different batches, & between brands because of a number of factors including: • Changes in season • Processing practices • Ingredient source
  3. 3. NUTTAB 2010 /nuttab2010/Contains data for approx 2600 foods available in Australia and up to 245 nutrients (online and electronic versions)Uses: A guide to the nutrient content of Australian foods for nutrition research and to assist consumers to make healthy food choices An education tool for schools and universities
  4. 4. Limitations of food composition tablesLimitations: Food supply changes quickly Biological variation of foods Single values representing range Incomplete data – missing foods & nutrients Bioavailability not considered Potential measurement & data entry error Relate to food supply of that country
  5. 5. Dietary Guidelines 2013 (NHMRC)Recommendations (‘guidelines’) which encourage healthy lifestyles that will minimise the risk of the development of diet related diseases within the Australian populationHighlight the groups of foods and lifestyle patterns that promote good nutrition and healthAvailable in ‘Eat for Health’ publication
  6. 6. Dietary Guidelines 2013Focus on: Contribution of core foods & major sources of energy (fat, starch & sugar) to the overall dietProvide: A practical way of informing consumers about food choices that are consistent with current dietary recommendations Separate guidelines for adults and children & adolescents
  7. 7. Dietary guidelines 2013Outlines how many serves a person should have of each food group based on their: age gender body size (to a degree) activity level (to a degree)Provides examples of what a serve is.
  8. 8. Dietary Guidelines 2013 – notes for useSummarise current nutrition knowledgeTrigger more comprehensive education programsRepresent best consensus of scientific knowledgeFor use by healthy adultsApply to whole diet not to individual foodsGuidelines are meant to be complementary not separate itemsNot appropriate for cross cultural issues or unusual habits
  9. 9. Recommended Dietary Intakes‘RDI’s’1991 – 2006Now replaced with the Nutrient Reference Values (NRVs)
  10. 10. Recommended Dietary Intakes 1991-2006 “The levels of essential nutrients considered, in the judgement of theNHMRC, on the basis of scientific knowledge to be adequate to meet the known nutritional needs of practically all healthy people.” i.e. they apply to group, not individual, needsRDIs were often misused to assess dietary adequacy of individuals &even foodsTo overcome this, many countries have now moved to a system ofreference values which retains the concept of the RDI but also attemptsto identify the average requirements needed by individuals
  11. 11. Nutrient Reference ValuesRetain the concept of the RDI Provide more complete information for decision making about nutritional status of individuals and groupsOutline the levels of intake of essential nutrients considered to be adequate to meet the known nutritional needs of practically all healthy people for prevention of deficiency states.The document can be used by health professionals to assess the likelihood of inadequate intake in individuals or groups of people.
  12. 12. NRV – An Umbrella TermThere are different NRV values for different nutrients:
  13. 13. Nutrient RequirementsDeveloped using reference (standard) body weights for different age groupsEstimated Energy Requirements (EERs) include physical activity level (PAL) consideration but refer to standardized weight for ageAdults well above and below the reference standard will have slightly different nutrient requirements (use RDI)
  14. 14. Estimated Average Requirement – EARDaily nutrient level estimated to meet the requirement of half the healthy individuals in a life stage/gender group (i.e. median value)Uses:Individuals: use to examine the probability that usual intake is inadequateGroups: use to estimate the prevalence of inadequate intakes within a group
  15. 15. Recommended Dietary Intake -RDIAverage daily dietary level sufficient to meet the nutrient requirements of NEARLY ALL (97-98%) healthy individuals in a life stage & gender groupUses:Individuals: usual intake at or above this level has a low probability of inadequacyGroups: DO NOT USE TO ASSESS GROUPS
  16. 16. Adequate Intake – AIAverage daily intake based on observed or experimentally-determined approximations or estimates of nutrient intake by a group of apparently healthy people that are assumed to be adequate Used when an RDI can not be determinedUses:Individuals: can be used as a goal for individual intake but use with caution if nutrient level is based on median intakes of healthy populationsGroups: if mean intake is at or above this level, a low prevalence of inadequacy is likely
  17. 17. Upper Limit – ULHighest level of continuing daily nutrient intake likely to pose no adverse health effects in almost all individualsUses:Individuals: usual intake above this level may place an individual at risk of adverse effects from excessive nutrient intakeGroups: use to estimate the % of the population at potential risk of adverse effects from excessive nutrient intake
  18. 18. Summary of the uses for the NRVsNRV Individuals GroupsEAR Use to determine probability usual Use to estimate prevalence of intake is inadequate inadequate intakes within groupRDI Usual intake at or above this level DO NOT USE TO ASSESS has a low probability of inadequacy INTAKES OF GROUPSAI Usual intake at or above has a low Mean usual intake at or above this probability of inadequacy. When AI level implies a low prevalence of is based on median intakes of inadequate intake. When AI is healthy population, interpret with based on median intakes of healthy caution. population, interpret with caution.UL Usual intake above this level may Use to estimate % of population at place individual at risk of adverse potential risk of adverse effects from effects from excessive intake excessive nutrient intake
  19. 19. EARRisk of deficiency AI Risk of excess RDI UL EAR estimated average requirement, AI adequate intake, RDI recommended dietary intake, UL upper limit
  20. 20. Suggested Dietary Targets (SDTs)Applicable to adolescents over 14 years and adultsA daily average intake from food and beverages for certain nutrients that may help in prevention of chronic diseaseFor most nutrients, the recommendation is based on the 90th centile of current population intake
  21. 21. Acceptable Macronutrient Distribution Range – AMDREstimate of the range of intake for each macronutrient for individuals which would allow for an adequate intake of all the other nutrients whilst maximising general health outcomesExpressed as % energyApplicable to adolescents over 14 years and adults
  22. 22. Recommendations for macronutrient intakes Recommendations: % of total energy Carbohydrate 45 – 65 Protein 15 – 25 Fat ≤30  saturated fat ≤10  mono-unsaturated fat ≥10
  23. 23. Anthropometric Reference Values for childrenGrowth curves used: Children above the 85th percentile are  weight for age generally considered overweight and above  height for age the 97th percentile are considered obese  weight for height  head circumference for ageWHO & CDC charts usedWHO growth standards:CDC growth charts:
  24. 24. Anthropometric Reference ValuesFor adults: Body Mass Index (BMI) (discussed last week) WHO classification  18.5-24.99 Normal range  > 25 Overweight  ≥ 30 Obese
  25. 25. Previous food selection guides5 food groups (Federal Health, 1940s)Healthy Eating Pyramid (NA, 1981)12345+ Food & Nutrition Plan (CSIRO, 1990s)
  26. 26. Core Food Groups (1995)National Health and Medical Research CouncilReplaced the 5 food groupsCurrently Under ReviewProvide 70% of RDI for vitamins & minerals 50% of RDI for protein 50% Energy RequirementsNutrient basedDaily food intakesNo indulgence foods or fats
  27. 27. The Australian Guide to Healthy EatingPlate/pie shaped rather than a pyramidBased on 5 food groups bread, cereal, rice, pasta, noodles vegetables, legumes Fruit milk, yoghurt, cheese meat, fish, poultry, eggs, nuts, legumesEach section represents proportions of that food group eaten in 1 day – not 1 meal
  28. 28. The AGTHE – what’s outside the circle?Water – key messages 8 glasses or 2L of water every day More required when physically active & in hot weather All fluids, other than alcohol, contributeExtra foods – key messages Choose these sometimes or in small amounts Not essential to provide nutrients the body needs Guide allows them to be considered in the context of selecting a healthy eating pattern
  29. 29. The Mediterranean Diet Pyramid
  30. 30. The Asian Diet Pyramid
  31. 31. Food VarietyMeans choosing a mixture of food: across the range of food groups from within food typesMore desirable: to have meals with many ingredients in small amounts than to have meals with few ingredients in large amounts
  32. 32. Food-based Dietary GuidelinesWHO recommends dietary are more practical & user- guidelines should be food based friendly promote enjoyment & taste avoid references to nutrients Based upon scientific evidence address traditional foods, dishes & cuisines – as per other dietary guidelines Not developed in Australia
  33. 33. Food Selection Guides Need to be:  Scientifically complete, yet contain simple key messages  Logical yet provide consumer understanding  Reflect foods commonly consumed in Australia  Represent a range of foods within each group  Be affordableAlbania  Be culturally acceptable  Reflect the nature of the food supply Slovenia  Be consistent with reference standards & DGsEstonia Poland Croatia