SlideShare a Scribd company logo
1 of 37
Newer aspects of Iron supplementation Newer aspects of Iron supplementation
Today’s discussion What we know! What we may not know! What we need to know!
What we know!
Anemia in pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anemia in pregnancy  - consequences   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Recommendations to counter IDA ,[object Object],[object Object]
ACOG Recommendations ,[object Object],[object Object],[object Object],[object Object],Which Iron salt?
What me may not know!  How do the iron salts compare, with each claiming to be better!
Different classes of Iron salts ,[object Object],Inorganic Ferrous Sulphate Ferrous Fumarate Ferric ammonium citrate Technological Ferrous ascorbate Elemental Carbonyl Iron Organic Ferric  Polymaltose Chelated iron Ferrous bis glycinate
Iron formulation adoption curve Unrealistic Over-enthusiasm Initial optimism Backlash antipathy Realistic adoption New concept
Iron absorption parameters 6.Bioavailability 5. Elemental iron 7. Phytate inhibition 2. Form administered   4. Dose 3. Status of patient's iron stores 1. Stability in gastric acids
Iron absorption parameters Elemental iron:   Amount of iron in a supplement that is available for absorption. Bioavailability:   Fraction of the elemental iron that reaches the systemic circulation Phytate inhibition  reducing the absorption of iron by 15-fold
Iron absorption parameters ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1. Iron salts and stomach ,[object Object],[object Object],[object Object],[object Object]
2. Elemental content of Iron salts ,[object Object],[object Object],[object Object]
2. Elemental content of Iron salts  ,[object Object],[object Object]
3. Absorbability of Iron salts  ,[object Object],[object Object]
4. Varying influences & iron absorption ,[object Object],[object Object],[object Object],[object Object]
4. Varying influences & iron absorption ,[object Object],[object Object],[object Object],[object Object]
Relative impact of phytate removal vs. ascorbic acid addition ,[object Object],[object Object]
What we need to know!
Chelated Amino acid Iron complex ,[object Object],1. Bovell-Benjamin AC et al.  Am J Clin Nutr . 2000;71:1563-1569. ,[object Object],[object Object]
Chelated Iron: reactivity ,[object Object]
Chelated Iron: consistency ,[object Object]
Chelated Iron: bio-absorbable ,[object Object]
Chelated Iron: advantages ,[object Object],[object Object],[object Object]
Chelated Iron: no inhibition ,[object Object]
Chelated Iron: tolerability ,[object Object]
Chelated Iron: stability constant ,[object Object],[object Object],[object Object],[object Object],[object Object]
Chelated Iron: absorption ratio ,[object Object],[object Object],[object Object],[object Object]
Chelated Iron: bioavailability ,[object Object],[object Object],[object Object]
Chelated Iron:  ↑  absorption ,[object Object],[object Object],[object Object]
Chelated Iron: -ve feedback ,[object Object],[object Object]
Chelated Iron: regulation ,[object Object],[object Object],[object Object],[object Object]
Chelated Iron: comparison ,[object Object],[object Object],Sodium Ferric Edetate ,[object Object],Ferrous Ascorbate ,[object Object],[object Object],Carbonyl iron
Ferrous ascorbate ,[object Object],The American Society for Nutritional Sciences J. Nutr. 134:395-398, February 2004
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],Unique chelate design potentially allows for smaller doses with fewer complaints due to better biovailability.

More Related Content

What's hot

Drug club presentation on accrufer
Drug club presentation on accruferDrug club presentation on accrufer
Drug club presentation on accrufer
Boyalakshmi
 
Magnesium [autosaved]
Magnesium [autosaved]Magnesium [autosaved]
Magnesium [autosaved]
Sameer Verma
 
Drug treatment of iron deficiency anaemia
Drug treatment of iron deficiency anaemiaDrug treatment of iron deficiency anaemia
Drug treatment of iron deficiency anaemia
Naser Tadvi
 
Pharmacology anemia and its treatment
Pharmacology   anemia and its treatmentPharmacology   anemia and its treatment
Pharmacology anemia and its treatment
MBBS IMS MSU
 

What's hot (20)

Bis glycinate vs ascorbate
Bis glycinate vs ascorbateBis glycinate vs ascorbate
Bis glycinate vs ascorbate
 
Ferrous ascorbate current clinical place in management of ida
Ferrous ascorbate current clinical place in management of idaFerrous ascorbate current clinical place in management of ida
Ferrous ascorbate current clinical place in management of ida
 
Drug club presentation on accrufer
Drug club presentation on accruferDrug club presentation on accrufer
Drug club presentation on accrufer
 
Iron deficiency anemia
Iron deficiency anemiaIron deficiency anemia
Iron deficiency anemia
 
Iron Deficiency Anaemia
Iron Deficiency AnaemiaIron Deficiency Anaemia
Iron Deficiency Anaemia
 
Iron defficiency anemia
Iron defficiency anemiaIron defficiency anemia
Iron defficiency anemia
 
Magnesium [autosaved]
Magnesium [autosaved]Magnesium [autosaved]
Magnesium [autosaved]
 
Drug treatment of iron deficiency anaemia
Drug treatment of iron deficiency anaemiaDrug treatment of iron deficiency anaemia
Drug treatment of iron deficiency anaemia
 
hematinics
hematinics hematinics
hematinics
 
Final anemia
Final anemiaFinal anemia
Final anemia
 
Iron deficiency anemia
Iron deficiency anemiaIron deficiency anemia
Iron deficiency anemia
 
IRON DEFICIENCY ANAEMIA
IRON DEFICIENCY ANAEMIAIRON DEFICIENCY ANAEMIA
IRON DEFICIENCY ANAEMIA
 
Pharmacology anemia and its treatment
Pharmacology   anemia and its treatmentPharmacology   anemia and its treatment
Pharmacology anemia and its treatment
 
Iron deficiency anemia
Iron deficiency anemiaIron deficiency anemia
Iron deficiency anemia
 
iron deficiency anemia
 iron deficiency anemia iron deficiency anemia
iron deficiency anemia
 
Multivitamin - Multimineral
Multivitamin - MultimineralMultivitamin - Multimineral
Multivitamin - Multimineral
 
Iron deficiency anemia final
Iron deficiency anemia finalIron deficiency anemia final
Iron deficiency anemia final
 
Iron deficiency anemia
Iron deficiency anemia  Iron deficiency anemia
Iron deficiency anemia
 
Haematinics
HaematinicsHaematinics
Haematinics
 
iron preparation
 iron preparation iron preparation
iron preparation
 

Viewers also liked

Adolescent onset anemia new
Adolescent onset anemia newAdolescent onset anemia new
Adolescent onset anemia new
Ashok Moses
 
Anaemia in pregnancy
Anaemia in pregnancyAnaemia in pregnancy
Anaemia in pregnancy
raj kumar
 
Anaemia in pregnancy
Anaemia in pregnancyAnaemia in pregnancy
Anaemia in pregnancy
Rama Thakur
 
Iron metabolism, iron deficiency
Iron metabolism, iron deficiencyIron metabolism, iron deficiency
Iron metabolism, iron deficiency
Guvera Vasireddy
 
Anatomy and physiology
Anatomy and physiologyAnatomy and physiology
Anatomy and physiology
Ashok Moses
 
Diabetes mellitus
Diabetes mellitusDiabetes mellitus
Diabetes mellitus
Ashok Moses
 
Powerpoint skin colour_and_vitiligo
Powerpoint skin colour_and_vitiligoPowerpoint skin colour_and_vitiligo
Powerpoint skin colour_and_vitiligo
Ashok Moses
 

Viewers also liked (20)

Adolescent onset anemia new
Adolescent onset anemia newAdolescent onset anemia new
Adolescent onset anemia new
 
Iron deficiency anemia
Iron deficiency anemiaIron deficiency anemia
Iron deficiency anemia
 
Anemia ppt
Anemia pptAnemia ppt
Anemia ppt
 
Performance iron amino acid complex data sheet
Performance iron amino acid complex data sheetPerformance iron amino acid complex data sheet
Performance iron amino acid complex data sheet
 
Anaemia in pregnancy
Anaemia in pregnancyAnaemia in pregnancy
Anaemia in pregnancy
 
Anti anaemic drugs (1)
Anti anaemic drugs (1)Anti anaemic drugs (1)
Anti anaemic drugs (1)
 
Folate
FolateFolate
Folate
 
Anemia in pregnancy &role of parenteral iron therapy
Anemia in pregnancy &role of parenteral iron therapyAnemia in pregnancy &role of parenteral iron therapy
Anemia in pregnancy &role of parenteral iron therapy
 
Anemia in Pregnancy
Anemia in PregnancyAnemia in Pregnancy
Anemia in Pregnancy
 
Anaemia in pregnancy
Anaemia in pregnancyAnaemia in pregnancy
Anaemia in pregnancy
 
Folic acid (B9)
Folic acid (B9)Folic acid (B9)
Folic acid (B9)
 
Anemia
AnemiaAnemia
Anemia
 
Iron metabolism, iron deficiency
Iron metabolism, iron deficiencyIron metabolism, iron deficiency
Iron metabolism, iron deficiency
 
Performance Supplementation Crash Course - Sigma Nutrition
Performance Supplementation Crash Course - Sigma NutritionPerformance Supplementation Crash Course - Sigma Nutrition
Performance Supplementation Crash Course - Sigma Nutrition
 
Anaemia It's ifa presentation
Anaemia It's ifa presentationAnaemia It's ifa presentation
Anaemia It's ifa presentation
 
Anatomy and physiology
Anatomy and physiologyAnatomy and physiology
Anatomy and physiology
 
Diabetes mellitus
Diabetes mellitusDiabetes mellitus
Diabetes mellitus
 
Matt S-J Poster
Matt S-J PosterMatt S-J Poster
Matt S-J Poster
 
Powerpoint skin colour_and_vitiligo
Powerpoint skin colour_and_vitiligoPowerpoint skin colour_and_vitiligo
Powerpoint skin colour_and_vitiligo
 
Iron is the most abundant mineral on this planet, yet we often have problems ...
Iron is the most abundant mineral on this planet, yet we often have problems ...Iron is the most abundant mineral on this planet, yet we often have problems ...
Iron is the most abundant mineral on this planet, yet we often have problems ...
 

Similar to Iron Salt Comparison New

Iron def.ninad final
Iron def.ninad finalIron def.ninad final
Iron def.ninad final
drninadphade
 

Similar to Iron Salt Comparison New (20)

Iron Deficiency Anemia.pptx
Iron Deficiency Anemia.pptxIron Deficiency Anemia.pptx
Iron Deficiency Anemia.pptx
 
FERRO da hemoglobina II. O que sabemos?
FERRO da hemoglobina II.  O que sabemos?FERRO da hemoglobina II.  O que sabemos?
FERRO da hemoglobina II. O que sabemos?
 
Official Compounds of Iron by Subodh Pharma Learning
Official Compounds of Iron by Subodh Pharma LearningOfficial Compounds of Iron by Subodh Pharma Learning
Official Compounds of Iron by Subodh Pharma Learning
 
Iron def.ninad final
Iron def.ninad finalIron def.ninad final
Iron def.ninad final
 
Heme iron. What do we know?
Heme iron. What do we know?Heme iron. What do we know?
Heme iron. What do we know?
 
Hemoglobin as supplementation. Why and how.
Hemoglobin as supplementation. Why and how.Hemoglobin as supplementation. Why and how.
Hemoglobin as supplementation. Why and how.
 
IRON_METABOLISM[1].pptx
IRON_METABOLISM[1].pptxIRON_METABOLISM[1].pptx
IRON_METABOLISM[1].pptx
 
Iron deficiency anemia
Iron deficiency anemiaIron deficiency anemia
Iron deficiency anemia
 
Trace minerals
Trace mineralsTrace minerals
Trace minerals
 
Starry Starry Night - Vincent
Starry Starry Night - VincentStarry Starry Night - Vincent
Starry Starry Night - Vincent
 
Ferrodyn 01 iron absorption and metabolism
Ferrodyn 01 iron absorption and metabolismFerrodyn 01 iron absorption and metabolism
Ferrodyn 01 iron absorption and metabolism
 
Iron deficiency anemia
Iron deficiency anemiaIron deficiency anemia
Iron deficiency anemia
 
Frequently asked questions about heme iron and supplementation.
Frequently asked questions about heme iron and supplementation.Frequently asked questions about heme iron and supplementation.
Frequently asked questions about heme iron and supplementation.
 
IRON METABOLISM 101.pptx
IRON METABOLISM 101.pptxIRON METABOLISM 101.pptx
IRON METABOLISM 101.pptx
 
What do we know II, some more published studies on heme iron
What do we know II, some more published studies on heme ironWhat do we know II, some more published studies on heme iron
What do we know II, some more published studies on heme iron
 
What do we know II ?
What do we know II ?What do we know II ?
What do we know II ?
 
Ferro Heme, O que sabemos? Estudos publicados sobre suplementação com ferro heme
Ferro Heme, O que sabemos? Estudos publicados sobre suplementação com ferro hemeFerro Heme, O que sabemos? Estudos publicados sobre suplementação com ferro heme
Ferro Heme, O que sabemos? Estudos publicados sobre suplementação com ferro heme
 
Peptides in anemia
Peptides in anemiaPeptides in anemia
Peptides in anemia
 
Iron deficiency anemia.
Iron deficiency anemia.Iron deficiency anemia.
Iron deficiency anemia.
 
HAEMATINICS 1.pptx
HAEMATINICS 1.pptxHAEMATINICS 1.pptx
HAEMATINICS 1.pptx
 

More from BALASUBRAMANIAM IYER

Risk stratification in post cardiac event cases
Risk stratification in post cardiac event casesRisk stratification in post cardiac event cases
Risk stratification in post cardiac event cases
BALASUBRAMANIAM IYER
 

More from BALASUBRAMANIAM IYER (20)

Project Status Report PowerPoint Template.pptx
Project Status Report PowerPoint Template.pptxProject Status Report PowerPoint Template.pptx
Project Status Report PowerPoint Template.pptx
 
dyslipidemia6.ppt
dyslipidemia6.pptdyslipidemia6.ppt
dyslipidemia6.ppt
 
Cancer and immunology
Cancer and immunologyCancer and immunology
Cancer and immunology
 
Stem cells in cardiac care
Stem cells in cardiac careStem cells in cardiac care
Stem cells in cardiac care
 
Telmisartan combination uses
Telmisartan combination usesTelmisartan combination uses
Telmisartan combination uses
 
Infiximab
InfiximabInfiximab
Infiximab
 
Temisartan + chlorthalidone
Temisartan + chlorthalidoneTemisartan + chlorthalidone
Temisartan + chlorthalidone
 
Rrt
RrtRrt
Rrt
 
1
11
1
 
News2
News2News2
News2
 
Cilnidipine
CilnidipineCilnidipine
Cilnidipine
 
NGAL - Acute kidney injury biomarker
NGAL - Acute kidney injury biomarkerNGAL - Acute kidney injury biomarker
NGAL - Acute kidney injury biomarker
 
Are all arbs the same?
Are all arbs the same?Are all arbs the same?
Are all arbs the same?
 
Amh test
Amh testAmh test
Amh test
 
Karyotyping
KaryotypingKaryotyping
Karyotyping
 
Ca
CaCa
Ca
 
Amh
AmhAmh
Amh
 
Torch
TorchTorch
Torch
 
Triple maternal screen
Triple maternal screenTriple maternal screen
Triple maternal screen
 
Risk stratification in post cardiac event cases
Risk stratification in post cardiac event casesRisk stratification in post cardiac event cases
Risk stratification in post cardiac event cases
 

Recently uploaded

Hyatt driving innovation and exceptional customer experiences with FIDO passw...
Hyatt driving innovation and exceptional customer experiences with FIDO passw...Hyatt driving innovation and exceptional customer experiences with FIDO passw...
Hyatt driving innovation and exceptional customer experiences with FIDO passw...
FIDO Alliance
 
Easier, Faster, and More Powerful – Alles Neu macht der Mai -Wir durchleuchte...
Easier, Faster, and More Powerful – Alles Neu macht der Mai -Wir durchleuchte...Easier, Faster, and More Powerful – Alles Neu macht der Mai -Wir durchleuchte...
Easier, Faster, and More Powerful – Alles Neu macht der Mai -Wir durchleuchte...
panagenda
 

Recently uploaded (20)

Long journey of Ruby Standard library at RubyKaigi 2024
Long journey of Ruby Standard library at RubyKaigi 2024Long journey of Ruby Standard library at RubyKaigi 2024
Long journey of Ruby Standard library at RubyKaigi 2024
 
AI mind or machine power point presentation
AI mind or machine power point presentationAI mind or machine power point presentation
AI mind or machine power point presentation
 
ERP Contender Series: Acumatica vs. Sage Intacct
ERP Contender Series: Acumatica vs. Sage IntacctERP Contender Series: Acumatica vs. Sage Intacct
ERP Contender Series: Acumatica vs. Sage Intacct
 
Microsoft CSP Briefing Pre-Engagement - Questionnaire
Microsoft CSP Briefing Pre-Engagement - QuestionnaireMicrosoft CSP Briefing Pre-Engagement - Questionnaire
Microsoft CSP Briefing Pre-Engagement - Questionnaire
 
Hyatt driving innovation and exceptional customer experiences with FIDO passw...
Hyatt driving innovation and exceptional customer experiences with FIDO passw...Hyatt driving innovation and exceptional customer experiences with FIDO passw...
Hyatt driving innovation and exceptional customer experiences with FIDO passw...
 
Where to Learn More About FDO _ Richard at FIDO Alliance.pdf
Where to Learn More About FDO _ Richard at FIDO Alliance.pdfWhere to Learn More About FDO _ Richard at FIDO Alliance.pdf
Where to Learn More About FDO _ Richard at FIDO Alliance.pdf
 
How we scaled to 80K users by doing nothing!.pdf
How we scaled to 80K users by doing nothing!.pdfHow we scaled to 80K users by doing nothing!.pdf
How we scaled to 80K users by doing nothing!.pdf
 
Working together SRE & Platform Engineering
Working together SRE & Platform EngineeringWorking together SRE & Platform Engineering
Working together SRE & Platform Engineering
 
The Value of Certifying Products for FDO _ Paul at FIDO Alliance.pdf
The Value of Certifying Products for FDO _ Paul at FIDO Alliance.pdfThe Value of Certifying Products for FDO _ Paul at FIDO Alliance.pdf
The Value of Certifying Products for FDO _ Paul at FIDO Alliance.pdf
 
Continuing Bonds Through AI: A Hermeneutic Reflection on Thanabots
Continuing Bonds Through AI: A Hermeneutic Reflection on ThanabotsContinuing Bonds Through AI: A Hermeneutic Reflection on Thanabots
Continuing Bonds Through AI: A Hermeneutic Reflection on Thanabots
 
Event-Driven Architecture Masterclass: Integrating Distributed Data Stores Ac...
Event-Driven Architecture Masterclass: Integrating Distributed Data Stores Ac...Event-Driven Architecture Masterclass: Integrating Distributed Data Stores Ac...
Event-Driven Architecture Masterclass: Integrating Distributed Data Stores Ac...
 
Human Expert Website Manual WCAG 2.0 2.1 2.2 Audit - Digital Accessibility Au...
Human Expert Website Manual WCAG 2.0 2.1 2.2 Audit - Digital Accessibility Au...Human Expert Website Manual WCAG 2.0 2.1 2.2 Audit - Digital Accessibility Au...
Human Expert Website Manual WCAG 2.0 2.1 2.2 Audit - Digital Accessibility Au...
 
Easier, Faster, and More Powerful – Alles Neu macht der Mai -Wir durchleuchte...
Easier, Faster, and More Powerful – Alles Neu macht der Mai -Wir durchleuchte...Easier, Faster, and More Powerful – Alles Neu macht der Mai -Wir durchleuchte...
Easier, Faster, and More Powerful – Alles Neu macht der Mai -Wir durchleuchte...
 
Introduction to FIDO Authentication and Passkeys.pptx
Introduction to FIDO Authentication and Passkeys.pptxIntroduction to FIDO Authentication and Passkeys.pptx
Introduction to FIDO Authentication and Passkeys.pptx
 
WebAssembly is Key to Better LLM Performance
WebAssembly is Key to Better LLM PerformanceWebAssembly is Key to Better LLM Performance
WebAssembly is Key to Better LLM Performance
 
Oauth 2.0 Introduction and Flows with MuleSoft
Oauth 2.0 Introduction and Flows with MuleSoftOauth 2.0 Introduction and Flows with MuleSoft
Oauth 2.0 Introduction and Flows with MuleSoft
 
ADP Passwordless Journey Case Study.pptx
ADP Passwordless Journey Case Study.pptxADP Passwordless Journey Case Study.pptx
ADP Passwordless Journey Case Study.pptx
 
ASRock Industrial FDO Solutions in Action for Industrial Edge AI _ Kenny at A...
ASRock Industrial FDO Solutions in Action for Industrial Edge AI _ Kenny at A...ASRock Industrial FDO Solutions in Action for Industrial Edge AI _ Kenny at A...
ASRock Industrial FDO Solutions in Action for Industrial Edge AI _ Kenny at A...
 
Intro in Product Management - Коротко про професію продакт менеджера
Intro in Product Management - Коротко про професію продакт менеджераIntro in Product Management - Коротко про професію продакт менеджера
Intro in Product Management - Коротко про професію продакт менеджера
 
Portal Kombat : extension du réseau de propagande russe
Portal Kombat : extension du réseau de propagande russePortal Kombat : extension du réseau de propagande russe
Portal Kombat : extension du réseau de propagande russe
 

Iron Salt Comparison New

  • 1. Newer aspects of Iron supplementation Newer aspects of Iron supplementation
  • 2. Today’s discussion What we know! What we may not know! What we need to know!
  • 4.
  • 5.
  • 6.
  • 7.
  • 8. What me may not know! How do the iron salts compare, with each claiming to be better!
  • 9.
  • 10. Iron formulation adoption curve Unrealistic Over-enthusiasm Initial optimism Backlash antipathy Realistic adoption New concept
  • 11. Iron absorption parameters 6.Bioavailability 5. Elemental iron 7. Phytate inhibition 2. Form administered 4. Dose 3. Status of patient's iron stores 1. Stability in gastric acids
  • 12. Iron absorption parameters Elemental iron: Amount of iron in a supplement that is available for absorption. Bioavailability: Fraction of the elemental iron that reaches the systemic circulation Phytate inhibition reducing the absorption of iron by 15-fold
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21. What we need to know!
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.

Editor's Notes

  1. Speaker Notes For purposes of this presentation, we will use the definitions on this and the following 3 slides Many of these definitions have been established by organizations involved in developing nutritional guidelines for groups and populations Some of them were agreed upon by the Council for purposes of the roundtable discussion—these are marked with a double asterisk We will use these definitions to maintain a common language as we discuss prenatal nutrition I won’t comment on all of them, but will focus on those that may not be as familiar as others An adequate intake, or AI, value is established for a nutrient when there is insufficient scientific data available to establish an RDA An AI level generally meets or exceeds the amount of a nutrient needed to maintain an adequate nutritional state in the majority of members of a specific age and gender group Dietary reference intakes , or DRIs , are a comprehensive set of nutrient reference values for healthy populations that can be used to plan and assess appropriate diets DRIs reflect the current state of scientific knowledge regarding nutrient requirements and include RDAs, AIs , and tolerable upper intake levels
  2. Speaker Notes For purposes of this presentation, we will use the definitions on this and the following 3 slides Many of these definitions have been established by organizations involved in developing nutritional guidelines for groups and populations Some of them were agreed upon by the Council for purposes of the roundtable discussion—these are marked with a double asterisk We will use these definitions to maintain a common language as we discuss prenatal nutrition I won’t comment on all of them, but will focus on those that may not be as familiar as others An adequate intake, or AI, value is established for a nutrient when there is insufficient scientific data available to establish an RDA An AI level generally meets or exceeds the amount of a nutrient needed to maintain an adequate nutritional state in the majority of members of a specific age and gender group Dietary reference intakes , or DRIs , are a comprehensive set of nutrient reference values for healthy populations that can be used to plan and assess appropriate diets DRIs reflect the current state of scientific knowledge regarding nutrient requirements and include RDAs, AIs , and tolerable upper intake levels