Nutritional Requirements

Learning objectives

By the end of the session, the students will be
able to:
• Be familiar with def in itions & concepts of
nutrient reference levels
• Be familiar with developing nutrient reference
levels
• Briefly describe applications of nutrient reference
levels
• Be familiar with Nutritional requirement during
critical periods
• Outline Nutrient-based vs. food-based dietary
guidelines
 Requirements - Introduction and
Historical
Five decades ago:
Overview

• "the problem of assessing the calorie and nutrient

requirements of human beings, with the greatest
possible degree of accuracy, is of basic importance
to FAO" (FAO, 1950).

• T he f ir st atte m p t to e stab l i sh hum an e ne rg y

requirement at population level was carried out by
FAO in 1950
 Principles and Definitions

• Human energy requirements are estimated from

m easures of energ y exp enditure p lus the
additional energy needs for growth, pregnancy
and lactation.

• Energy balance is achieved when input (i.e.

dietary energy intake) is equal to output (i.e. total
energy expenditure), plus the energy cost of
growth in childhood and pregnancy, or the energy
cost to produce milk during lactation.
• When energy balance is maintained over a
prolonged period, an individual is considered to
be in a steady state.

• The dietary requirement for a nutrient is an intake

level which m eets a specif ie d criteria for
adequacy, thereby minimizing risk of nutrient
deficit or excess.
• An adequate, healthy diet must satisfy human
needs for energy and all essential nutrients

• Furtherm ore, dietary energy needs and

recommendations cannot be considered in isolation
of other nutrients in the diet, as the lack of one will
influence the others.

• Therefore, the assumption is that requirements for

energy will be fulfilled through the consumption of a
diet that satisfies all nutrient needs
• Requirement
– Minimum amount of a nutrient needed to sustain
a physiological state, function, or structure in an
individual.
• Recommendation
– Normalized estimate of nutrient needed to cover
most individuals in a population group.

• Guideline: Advice on diet composition to population

groups, aimed at maintaining health and preventing
diseases
 The dietary requirement
• These criteria cover a gradient of biological
effects related to a range of nutrient intakes
which, at the extremes, include the intake
required to prevent death associated with
nutrient deficit or excess

• For nutrients where insuf ficient data on mortality

are available
– clinical disease
– subclinical conditions identif ie d by specif ic
biochemical and functional measures
– Measures of nutrient stores or critical tissue
pools may also be used
Dietary Reference Intakes (DRIs)

– Estimated Average Requirement (EAR)

– Recommended Dietary Allowance (RDA)
– Adequate Intake (AI)
– Tolerable Upper Intake Level (UL)
– Protective nutrient intake
1. Estimated average requirement

 Estimated average requirement (EAR) is the

average daily nutrient intake level that meets the
needs of 50% of the “healthy” individuals in a
particular age and gender group

 50% of subjects would not have their needs met

 Limited in number due to few human studies

 2. Recommended nutrient intake
(RNI)
• The daily intake, set at the EAR plus 2 standard
dev iations ( SD), which m eets the nutrient
requirements of almost all apparently healthy
individuals in an age- and sex-specif ic population
group.

• If the distribution of requirement values is not known,

a normal distribution can be assumed, and from this
it is expected that the mean requirement plus 2 SD
will cover the nutrient needs of 97.5% of the
population.
Recommended daily Allowances (RDAs)

• “. . . levels of intake of essential nutrients

considered, in the judgment of the Food and
Nutrition Board on the basis of available scientific
knowledge, to be adequate to meet the known
nutritional needs of practically all healthy persons.”

• RNI = RDA as used by the Food and Nutrition

Board of the United States National Academy of
Sciences
Recommended Dietary Allowance

 Sufficient to meet the daily nutrient

requirements of most individuals in a specific
life stage and gender group

 Set at a level that is at the top two to three

percent of the requirement distribution

 Intended to serve as a goal for daily intake by

individuals
 3. Adequate Intake (AI)
 Establish for the nutrient if sufficient scientific
evidence is not available to establish an EAR inturn
RDA
 The AI based on

Observed or experimentally determined

approximations or
Estimates of nutrient intake of people with adequate
nutritional state
14
 Adequate Intake (AI) cont....
 The AI is expected to meet or exceed the needs of
most individuals in a specific life-stage and
gender group.

 When an RDA is not available for a nutrient, the AI

can be used as the goal for usual intake by an
individual.
 4. Tolerable Upper Intake Level
• Upper limits (ULs) of nutrient intake have been set
for some micronutrients and are def ined as the
m axim um intake from food, water and
supplements that is unlikely to pose risk of adverse
health effects from excess in almost all (97.5%)
apparently healthy individuals in an age- and sex-
specific population group.

• The range of intakes between the RNI and UL

sho ul d b e c o nsi d e re d suf fic i e nt to p rev e nt
deficiency while avoiding toxicity.
• Highest level of daily nutrient intake that is likely
to pose no risks of adverse health effects to
almost all individuals in the general population

• Determined by risk assessment methods

• Not intended to be a recommended level of

intake ( no ev idenc e of benef it for healthy
individuals in consuming nutrients above the RDA
or AI)


5. Protective nutrient intake

• The concept of protective nutrient intake has

been introduced for some micronutrients to refer
to an amount greater than the RNI which may be
p ro t e c t i v e a g a i nst a sp e c i f ie d he a l t h o r
nutritional risk of public health relevance.

(e.g. vitamin C intake of 25 mg with each meal

to enhance iron absorption and prevent anaemi
a.


Protective nutrient intake

• When existing data provide justif ia ble differences
between RNI values and protective intake levels
comment to that effect is made in the appropriate
chapter of this document. Protective intake levels are
expressed either as a daily value or as an amount to
be consumed with a meal.
 Energy requirement
• is the amount of food energy needed to balance
energy expenditure in order to maintain body size,
body composition and a level of necessary and
desirable physical activity consistent with long-
term good health
 Average requirement and inter-
individual variation
• Estimates of energy requirements are derived from
measurements of individuals

• Measurements of a collection of individuals of the

same gender and similar age, body size and
physical activity are grouped together to give the
average energy requirement – or recommended
level of dietary intake – for a class of people or a
population group
 Average requirement…
• These requirements are then used to predict the
requirements and recommended levels of energy
intake for other indiv iduals with sim ilar
characteristics, but on whom measurements have
not been made

• However, there remain unknown factors that

produce variations among individuals
Inter-individual Variation
Energy requirement
 Calculating Your Energy Needs
• Women
– 65.5 + (4.4 x wt. in pounds) + (4.3 x ht. in inches) – (4.7
x age)
• Men
– 66 + (6.2 x wt. in pounds) + (12.7 x ht. in inches) – (6.8 x
age)

• Note: this is just an estimate of your calorie needs

to carry out daily activity. It does not account for
exercise or strenuous work
 Energy Vs Nutrient requirements
• For most specif ic nutrients, a certain excess of
intake will not be harmful

• T hus, w he n d i e t ary re c o m m e nd at i o ns are

calculated for these nutrients, the variation among
individuals in a class or population group is taken
into account.

• The recommended level of intake is an amount

that will meet or exceed the requirements of
practically all individuals in the group
 Energy Vs Nutrient requirements
• This approach cannot be applied to dietary energy
recommendations, because intakes that exceed
requirements will produce a positive balance, which
may lead to overweight and obesity in the long term

• A high level of energy intake that assures a low

probability of energy deficiency for most people (e.g.
the average requirement plus 2 standard deviations)
also implies a high probability of obesity for most
people owing to a dietary energy excess
 Energy Requirement
• Women

• 65.5 + (4.4 x wt. in pounds) + (4.3 x ht.

in inches) – (4.7 x age)

• Men

• 66 + (6.2 x wt. in pounds) + (12.7 x ht.

in inches) – (6.8 x age)
Human energy requirements

• Human energy requirements are estimated

from measures of energy expenditure plus
the additional energy needs for growth,
pregnancy and lactation

ER=EE+ additional energy for growth

etc
Energy Vs Nutrient requirements

• Therefore, the dietary energy intake that could be

safely recommended for a population group is
the estimated average energy requirement of
that group.
Nutrient requirements
 Approaches used in estimating nutrient
intakes for optimal health

• The methods used to estimate nutritional
requirements have changed over time.
• Four currently used approaches are brief ly outlined
below:
 the clinical approach
 nutrient balance,
functional indicators of nutritional suf fic iency
(biochemical, physiological, molecular), and
optimal nutrient intake.


Approaches used in estimating nutrient
intakes for optimal health

• A detailed analysis of the relative merits of these
approaches is beyond the scope of this chapter, but
additional information on each can be found in
subsequent chapters of this report.

• When no information is available the default approach

to def ine a recommended intake based on the range
of observed intakes of "healthy” populations is used.


1. The clinical approach

• The traditional criteria to def ine essentiality of
nutrients for human health require that
A.) a disease state, or functional or structural
abnormality is present if the nutrient is absent or
deficient in the diet and,
B.) that the abnormalities are related to, or a
c onsequenc e of, spec if ic bioc hem ic al or
functional changes that can be reversed by the
presence of the essential dietary component.


2. Nutrient balance

• Nutrient balance calculations typically involve
asse ssi ng i np ut and outp ut and e stab l i shi ng
requirement at the point of equilibrium (except in the
case of childhood, pregnancy and lactation where the
additional needs for growth, tissue deposition and
milk secretion are considered).

• However, in most cases, balance based on input–

output measurements is greatly inf luenced by prior
level of intake, that is, subjects adjust to high intakes
by increasing output and, conversely, they lower
output when intake is low.


3. Functional responses

• Various biomarkers are presently being evaluated for

their specif ic ity and sensitivity to assess nutrient-
related organ function and thus predict def iciency or
toxicity.

• In terms of def in ing nutrient needs for optimal

f unc ti on, rec ent ef f or ts hav e f oc used on the
assessment of:

 Neurodevelopment: monitoring electro-physiologic

responses to def ined sensory stimuli; sleep–wake
 3. Functional responses

cont….
 Bone health: measuring bone mineral density by
X-ray absorptiometry; markers of collagen
synthesis and turnover; and hormonal responses
associated with bone anabolism and catabolis
m.

 Biochemical normalcy: measuring plasma and

tissue concentrations of substrates or nutrient
responsive enzymes, hormones or other indices
of anabolic and catabolic activity; and plasma
concentrations and tissue retention in response
to a fixed nutrient load


4. Optimal intake

• Optimal intake is a relatively new approach to
deriving nutrient requirements.

• The question “Optimal intake for what?” is

usually answered with the suggestion that a
balanced diet or specif ic nutrients can improve
physical and mental performance, enhance
immunity, prevent cancer, or add healthy years to
our life.

• This response is unfortunately often used too

g e ne ral l y, and i s usual l y unsup p o r te d b y


4. Optimal intake cont….

• The preferred approach to def ine optimal intake is
to clearly establish the function of interest and the
level of desired function .

• The selected function should be related in a

plausible manner to the specif ic nutrient or food
and serve to promote health or prevent disease.
 Dietary Guidelines Versus DRIs
 Dietary Guidelines
– Qualitative advice to the public about diet and
chronic disease prevention (e.g., the Food
Pyramid)

 DRIs
– Quantitative advice to professionals about
amounts of nutrients found to be of benefit
The Food Pyramid
Criteria for Diet-Disease Relationships

 Strength of association
 Dose-response relationship
 Temporally correct association
 Consistency of association
 Specificity of association
 Biological plausibility
Scientific Basis for Establishing DRIs

 Observed intakes in healthy populations

 Epidemiological observations
 Balance studies
 Depletion/repletion studies
 Animal experiments
 Biochemical measurements
 Components of Energy Requirements
Human beings need energy for the following:
1. Basal metabolism: comprises a series of functions that
are essential for life, such as cell function and
replacement; the synthesis, secretion and metabolism
of enzymes and hormones to transport proteins and
other substances and molecules; the maintenance of
body temperature; uninterrupted work of cardiac and
respiratory muscles; and brain function

– Depending on age and lifestyle, BMR represents 45 to

70 percent of daily total energy expenditure, and it is
determined mainly by the individual’s age, gender,
body size and body composition.
Infants
Infants
2. response to food: Eating requires energy for the
ingestion and digestion of food, and for the
absorption, transport, interconversion, oxidation
and deposition of nutrients

3. Physical activity:- This is the most variable and,

after BMR, the second largest component of
daily energy expenditure. Humans perform
obligatory and discretionary physical activities

4. Growth:- The energy cost of growth has two

components:
A. the energy needed to synthesize growing
tissues
B. the energy deposited in those tissues.
Components of Energy Requirements…

5. Pregnancy . During pregnancy, extra energy is

needed for the growth of the foetus, placenta
and various maternal tissues

6. Lactation. The energy cost of lactation has two

components:
A. the energy content of the milk secreted
B. the energy required to produce that milk


Uses of Human energy requirements
and recommendations
 Assess the adequacy of food supplies to meet
population nutrients needs

 Assessing the proportion and absolute number of

undernourished people worldwide

 Setting targets for food production

 Monitor nutrition programs and plan development

activities
 Chemical composition of a human
body weighing 65 kg
Component Percentage of body weight
Water 61.6

Protein 17

Fats 13.8

Minerals 6.1

Carbohydrate 1.5


Simple classification of dietary
constituents
Constituent use

1. Water provide body fluid & help regulate

body temperature
2. Carbohydrates As fuel for energy for body heat
and work
3. Fats As fuel for energy and essential
fatty acids
 Dietary constituents…
Constituent use
4. Proteins For growth and repair

5. Minerals For developing body tissues and for

metabolic processes and protection

6. Vitamins For metabolic processes and

protection
6.Fibers •Form a vehicle for other nutrients,
•Add bulk to the diet,
•Provide a habitat for bacterial flora
and assist proper elimination of
FAT=20% - 35%

CHO=45% - 65%

Pro=10% - 35%

53
 Vitamin A
Human requirements
• is 750 μg of retinol per day for adults; lactating
mothers need 50 percent more, and children and
infants less
Vitamins and minerals requirement chart
 Summary
• The quantitative def inition of nutrient needs and
their expression as recommended nutrient
intakes (RNI) have been important components
of food and nutrition policy and programme
implementation

• RNIs provide the f irm scientif ic basis necessary

to satisfy the requirements of a group of healthy
individuals and define adequacy of diets
 Summary
• I n c o n t ra s t t o R N I s , f o o d - b a s e d d i e t a r y
guidelines (FBDGs) as instruments of policy are
more closely linked to diet health relationships
of relevance to a particular country or region

• FBDGs take into account the customary dietary

pattern, the foods available, and the factors that
determ ine the c onsum ption of foods and
indicate what aspects should be modified