摘 要： 目的：探讨互联网药学信息交流的模式与应用.方法：比较了网上药学信息交流的形式以及对药学 各领域的影响.结果：网上药学信息交流的形式分为公告版、聊天室、电子邮件、新闻组、邮件列表等形式;并给药学科研、教育、服务、销售等领域的带来了方便 和高效.结论：互联网药学信息交流将大力促进药学各领域的发展.
Objective. To report the data from couples who were referred for preimplantation-genetic diagnostics (PGD) and treatment due to a significantly increased risk of offspring with a serious genetic disorder. Design. Descriptive， prospective. Method. Data were collected from couples that underwent PGD in the period I993/'03 at Maastricht University Hospital. Embryos produced by means of in-vitro fertilisation (IVF) were subjected to genetic tests several days after fertilisation. Subsequently i or 2 unaffected embryos were transferred to the uterus. Where there was an increased risk of a male with an X-linked genetic disorder， the gender was determined using fluorescence in-situ hybridisation (FISH). This method was also used to detect structural chromosomal abnormalities. The polymerase chain reaction (PCR) method was used for mutation detection and/or marker analysis of monogenetic disorders. Results. A total of 69I couples were referred for PGD. The most frequent indications were X-linked disorders (30%)， in particular Fragile-X syndrome， Duchenne/Becker muscular dystrophy and haemophilia A/B. This was followed by autosomal dominant disorders (26%)， such as Huntington's disease and myotonic dystrophy， and then structural chromosomal abnormalities (24%). A total of 120 women underwent 260 PGD cycles. An embryo transfer was possible in I58 of the cycles and this resulted in 45 successful pregnancies. The pregnancy rate was I7% per cycle initiated and 28% per cycle with embryo transfer. Up until december 2003 29 singletons， 8 sets of twins and I set of triplets were born. There were no misdiagnoses and none of the babies had congenital abnormalities. Conclusion. PGD was a reliable and successful method， with pregnancy rates similar to those of IVF or intracytoplasmatic sperm injection. PGD should be stated as an alternative during the preconception counselling of couples with an increased genetic risk， especially for disorders where PGD can be routinely applied， such as Huntington's disease， myotonic dystrophy， cystic fibrosis， spinal muscular atrophy， Fragile-X syndrome and structural chromosomal abnormalities.
Book Review Virus Hunter: Thirty years of battling hot viruses around the world By C.J. Peters, with Mark Olshaker. 323 pp., illustrated. New York, Anchor Books, 1997. $23.95. 0-385-48557-3
Virus Hunter: by C. J. Peters. 323 pages, hardcover. Anchor Books, New York, 1996. ISBN 0-385-48557-3 $23.95
What with anecdotal reports of terrifying viruses， bacteria， and parasites of mice， men， and salads， it has occurred to some of us that the world may be going out of balance. This could be the ultimate price to be paid for dumping trash in oceans and air and for eating things grown in stuff we once would have flushed. As we outstrip the carrying capacity of our ecosystem， organisms that once quietly went about their business in rain forests， deserts， and plains， now are in our cupboards and neighbors and increasingly have become big news. Likely， these sources of job security have been there all the time but we had not noticed， for one reason or another. Now that we are doing a better job at recognition， the public is clamoring for motion pictures， TV programs， and books about these dramatic diseases. Such tales are all the more frightening than Stephen King stories because they are real.
摘 要： 目的：了解艾滋病网络咨询人群特征，提出网络防制措施。方法：采用聊天室答询及BBS、E—MAIL交流的方式进行调查。结果：咨询人群中，男女性别比为5.1：1；主要年龄为15～30岁；文化程度以大学、高中及初中学历为主；居前五位的职业分别是服务行业、个体户、流动打工者、学生和商业雇员；传播途径和高危行为以性接触为主，其次为共用注射器吸毒、输血／注射血液制品?HIV感染者主要咨询AIDS治疗、特效药、预后及有关AIDS法律；恐艾人群主要咨询HIV的传播途径、窗口期、潜伏期、临床症状、HIV检测手续和单位、预防方法。
Objective. Itemise blood transfusion incidents in the South-West Netherlands region (about 3.5 million inhabitants)， where a regional reporting system for transfusion incidents was introduced in January 200I. Design. Prospective， descriptive. Method. In the period I January 200I-3I December 200I， 22 hospitals voluntarily reported transfusion incidents in patients to the blond bank. All incidents were anonymously recorded in a standardised report and registered in 14 categories. Results， A total of II9 transfusion incidents were reported and categorised as： incorrect blood component transfused (n = 8)， mild fever I-2°C (n = I4)， non-haemolytic fever > 2°C (n = 36)， acute haemolytic transfusion reactions (n = 3)， delayed haemolytic transfusion reactions (n = I8)， allergic reactions (n = II)， bacterial contamination (n = 3)， transfusion-related acute lung injury (n = I)， near accidents (n = 6) and product recalls (n = I9). There were no reports in the categories anaphylactic shock， post-transfusion purpura， transfusion-acquired viral infection， and transfusion-related graft versus host disease. In the same year of haemovigilance， the blood bank issued a total of I58，000 blood products. A complication rate of I：700 blood products was calculated. It is estimated that 53% of all incidents were reported. Conclusion. Despite all of the safety measures taken， severe adverse events still occurred. A well-run system for haemo-vigilance can contribute to the knowledge of transfusion incidents. The safety and quality of blood transfusions Can be improved if this knowledge is incorporated into ongoing education about blood transfusions and in the prevention and treatment of transfusion reactions.
Visit the National Academies Press online， the authoritative source for all books from the National Academy of Sciences， the National Academy of Engineering， the Institute of Medicine， and the National Research Council： • Download hundreds of free books in PDF • Read thousands of books online for free • Explore our innovative research tools – try the “Research Dashboard” now! • Sign up to be notified when new books are published • Purchase printed books and selected PDF files Thank you for downloading this PDF. If you have comments， questions or just want more information about the books published by the National Academies Press， you may contact our customer service department toll-free at 888-624-8373， visit us online， or send an email to email@example.com. This book plus thousands more are available at http：//www.nap.edu. Copyright © National Academy of Sciences. All rights reserved. Unless otherwise indicated， all materials in this PDF File are copyrighted by the National Academy of Sciences. Distribution， posting， or copying is strictly prohibited without written permission of the National Academies Press. Request reprint permission for this book. ISBN： 0-309-52962-X， 224 pages， 6 x 9， (2003)This PDF is available from the National Academies Press at：http：//www.nap.edu/catalog/10872.htmlhttp：//www.nap.edu/catalog/10872.htmlWe ship printed books within 1 business day; personal PDFs are available immediately.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortification Committee on Use of Dietary Reference Intakes in Nutrition Labeling Committee on Use of Dietary Reference Intakes inNutrition LabelingFood and Nutrition BoardTHE NATIONAL ACADEMIES PRESSWashington， D.C.www.nap.eduDRIDIETARY REFERENCE INTAKESGuiding Principles forNutrition Labeling andFortificationCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlTHE NATIONAL ACADEMIES PRESS 500 Fifth Street， N.W. Washington， DC 20001NOTICE： The project that is the subject of this report was approved by the Governing Boardof the National Research Council， whose members are drawn from the councils of the Na-tional Academy of Sciences， the National Academy of Engineering， and the Institute of Med-icine. The members of the committee responsible for the report were chosen for their spe-cial competences and with regard for appropriate balance.Support for this project was provided by the Food and Drug Administration of the U.S.Department of Health and Human Services and the Food Safety and Inspection Service ofthe U.S. Department of Agriculture under Contract No. 223-01-2460， Task Orders 5 and 8，and by Health Canada under Contract No. H1021-020552/001/SS. The views presented inthis report are those of the Institute of Medicine Committee on Use of Dietary ReferenceIntakes in Nutrition Labeling and are not necessarily those of the funding agencies.Library of Congress Cataloging-in-Publication DataInstitute of Medicine (U.S.). Committee on Use of Dietary Reference Intakes in NutritionLabeling.Dietary reference intakes ： guiding principles for nutrition labeling and fortification /Committee on Use of Dietary Reference Intakes in Nutrition Labeling， Food and NutritionBoard.p. cm.Includes bibliographical references and index.ISBN 0-309-09132-2 (hardcover) — ISBN 0-309-09143-8 (pbk.) — ISBN 0-309-52962-X (pdf)1. Food—Labeling. 2. Nutrition. I. Title.TX551.I58 2004363.19’2—dc222004002799Additional copies of this report are available from the National Academies Press， 500 FifthStreet， N.W.， Lockbox 285， Washington， DC 20055; (800) 624-6242 or (202) 334-3313 (in theWashington metropolitan area); Internet， http：//www.nap.edu.For more information about the Institute of Medicine， visit the IOM home page at：www.iom.edu.Copyright 2003 by the National Academy of Sciences. All rights reserved.Printed in the United States of America.The serpent has been a symbol of long life， healing， and knowledge among almost all culturesand religions since the beginning of recorded history. The serpent adopted as a logotype bythe Institute of Medicine is a relief carving from ancient Greece， now held by the StaatlicheMuseen in Berlin.Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.html“Knowing is not enough; we must apply. Willing is not enough; we must do.” —GoetheAdviser to the Nation to Improve HealthCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlThe National Academy of Sciences is a private， nonprofit， self-perpetuating societyof distinguished scholars engaged in scientific and engineering research， dedicatedto the furtherance of science and technology and to their use for the generalwelfare. Upon the authority of the charter granted to it by the Congress in 1863，the Academy has a mandate that requires it to advise the federal government onscientific and technical matters. Dr. Bruce M. Alberts is president of the NationalAcademy of Sciences.The National Academy of Engineering was established in 1964， under the charterof the National Academy of Sciences， as a parallel organization of outstandingengineers. It is autonomous in its administration and in the selection of its members，sharing with the National Academy of Sciences the responsibility for advising thefederal government. The National Academy of Engineering also sponsors engi-neering programs aimed at meeting national needs， encourages education andresearch， and recognizes the superior achievements of engineers. Dr. Wm. A. Wulfis president of the National Academy of Engineering.The Institute of Medicine was established in 1970 by the National Academy ofSciences to secure the services of eminent members of appropriate professions inthe examination of policy matters pertaining to the health of the public. TheInstitute acts under the responsibility given to the National Academy of Sciencesby its congressional charter to be an adviser to the federal government and， uponits own initiative， to identify issues of medical care， research， and education.Dr. Harvey V. Fineberg is president of the Institute of Medicine.The National Research Council was organized by the National Academy of Sciencesin 1916 to associate the broad community of science and technology with theAcademy’s purposes of furthering knowledge and advising the federal government.Functioning in accordance with general policies determined by the Academy， theCouncil has become the principal operating agency of both the National Academyof Sciences and the National Academy of Engineering in providing services to thegovernment， the public， and the scientific and engineering communities. TheCouncil is administered jointly by both Academies and the Institute of Medicine.Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair， respectively， ofthe National Research Council.www.national-academies.orgCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlvCOMMITTEE ON USE OF DIETARY REFERENCE INTAKESIN NUTRITION LABELINGIRWIN H. ROSENBERG (chair)， Jean Mayer USDA HumanNutrition Research Center on Aging and Friedman School ofNutrition Science and Policy， Tufts University， Boston，MassachusettsSTEVEN A. ABRAMS， Department of Pediatrics， USDA/ARSChildren’s Nutrition Research Center， Baylor College ofMedicine， Houston， TexasGARY R. BEECHER， Lothian， MarylandCATHERINE M. CHAMPAGNE， Pennington BiomedicalResearch Center， Louisiana State University， Baton RougeFERGUS M. CLYDESDALE， Department of Food Science andNutrition， University of Massachusetts， AmherstJEANNE P. GOLDBERG， Center on Nutrition Communicationand Graduate Program in Nutrition Communication，Friedman School of Nutrition Science and Policy， TuftsUniversity， Boston， MassachusettsPENNY M. KRIS-ETHERTON， Department of NutritionalSciences， The Pennsylvania State University， University ParkJEROLD R. MANDE， Yale Cancer Center， Yale University Schoolof Medicine， New Haven， ConnecticutGEORGE P. MCCABE， Department of Statistics， PurdueUniversity， West Lafayette， IndianaFRANCES H. SELIGSON， Hershey， PennsylvaniaVALERIE TARASUK， Department of Nutrition Sciences，University of Toronto， OntarioSUSAN WHITING， College of Pharmacy and Nutrition， Universityof Saskatchewan， SaskatoonConsultantBERNADETTE M. MARRIOTT， Chapel Hill， North CarolinaCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlviStaffLINDA D. MEYERS， Study DirectorROMY GUNTER-NATHAN， Co-Study Director1GAIL SPEARS， Staff EditorTAZIMA DAVIS， Research Assistant2HARLEEN SETHI， Senior Project Assistant3SHANNON RUDDY， Senior Project Assistant41Until December 2002.2From June 2003.3Until September 2003.4From September 2003.Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlviiFOOD AND NUTRITION BOARDCATHERINE E. WOTEKI (chair)， College of Agriculture， IowaState University， AmesROBERT M. RUSSELL (vice chair)， Jean Mayer USDA HumanNutrition Research Center on Aging， Tufts University， Boston，MassachusettsLARRY R. BEUCHAT， Center for Food Safety， University ofGeorgia， GriffinBENJAMIN CABALLERO， Center for Human Nutrition， JohnsHopkins Bloomberg School of Public Health， Baltimore，MarylandSUSAN FERENC， SAF*Risk， LC， Madison， WisconsinNANCY F. KREBS， Department of Pediatrics， University ofColorado Health Sciences Center， DenverSHIRIKI KUMANYIKA， Center for Clinical Epidemiology andBiostatistics， University of Pennsylvania School of Medicine，PhiladelphiaLYNN PARKER， Child Nutrition Programs and Nutrition Policy，Food Research and Action Center， Washington， D.C.PER PINSTRUP-ANDERSEN， Division of Nutritional Sciences，Cornell University， Ithaca， New YorkA. CATHERINE ROSS， Department of Nutritional Sciences， ThePennsylvania State University， University ParkBARBARA O. SCHNEEMAN， Department of Nutrition， Universityof California， DavisNICHOLAS J. SCHORK， Polymorphism Research Laboratory，University of California， San DiegoJOHN W. SUTTIE， Department of Biochemistry， University ofWisconsin， MadisonSTEVE L. TAYLOR， Department of Food Science and Technologyand Food Processing Center， University of Nebraska， LincolnBARRY L. ZOUMAS， Department of Agricultural Economics andRural Sociology， The Pennsylvania State University， UniversityParkCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlviiiStaffALLISON A. YATES， Director5LINDA D. MEYERS， Deputy DirectorGAIL SPEARS， Staff EditorGERALDINE KENNEDO， Administrative AssistantGARY WALKER， Financial Associate5Until October 2003.Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlixReviewersThis report has been reviewed in draft form by individuals chosenfor their diverse perspectives and technical expertise， in accordancewith procedures approved by the NRC’s Report Review Committee.The purpose of this independent review is to provide candid andcritical comments that will assist the institution in making its pub-lished report as sound as possible and to ensure that the reportmeets institutional standards for objectivity， evidence， and respon-siveness to the study charge. The review comments and draft manu-script remain confidential to protect the integrity of the deliberativeprocess. We wish to thank the following individuals for their reviewof this report：Richard Black， International Life Sciences Institute， NorthAmerica; Susan Borra， International Food and InformationCouncil; Robert O. Earl， National Food Processors Associa-tion; John W. Erdman， University of Illinois; Nancy D. Ernst，Ernst Nutrition Consulting; Kenneth Fisher， KD Consultants;Cutberto Garza， Cornell University; Katherine Gray-Donald，McGill University; Peter Barton Hutt， Covington & Burling;Gilbert Leveille， Cargill， Inc.; Ian C. Munro， Cantox HealthSciences International; Suzanne P. Murphy， University ofHawaii; Lynn Parker， Food Research and Action Center;Donna Porter， Congressional Research Service; George F.Sheldon， The University of North Carolina at Chapel Hill;John Vanderveen， San Antonio， Texas; and Kathryn L.Wiemer， General Mills.Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlx REVIEWERSAlthough the reviewers listed above have provided many construc-tive comments and suggestions， they were not asked to endorse theconclusions or recommendations nor did they see the final draft ofthe report before its release. The review of this report was overseenby Maldon C. Nesheim， Cornell University， and Enriqueta Bond，Burroughs Wellcome Fund. Appointed by the Institute of Medicineand the National Research Council， they were responsible for makingcertain that an independent examination of this report was carriedout in accordance with institutional procedures and that all reviewcomments were carefully considered. Responsibility for the finalcontent of this report rests entirely with the authoring committeeand the institution.Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlxiPrefaceThe task for the Committee on Use of Dietary Reference Intakesin Nutrition Labeling， which I was privileged to chair， was to provideguidance to the U.S. Department of Health and Human Services’Food and Drug Administration (FDA)， the U.S. Department of Agri-culture’s Food Safety and Inspection Service (FSIS)， and HealthCanada on how to use the Dietary Reference Intakes (DRIs) toupdate the nutrient reference values used in nutrition labeling. Thecommittee was also asked to produce guidance on how to use theDRIs when making decisions about the discretionary fortification offood.The evolution of the current seven plus DRI volumes from a single-volume book of Recommended Dietary Allowances (RDAs) in theUnited States and from Recommended Nutrient Intakes (RNIs) inCanada reflects the tremendous surge in the scientific understand-ing of basic nutrition and the relationships between diet and healthin the 8 years between the publication of the last RDA and RNIbooks and the first volume of the DRIs. The DRIs are definitely notyour mother’s RDAs or RNIs! They include four reference values：the RDA， the Estimated Average Requirement (EAR)， the AdequateIntake (AI)， and the Tolerable Upper Intake Level (UL). (An over-view of the DRIs and their derivation is provided in Chapter 4.)The report before you represents the result of six meetings，numerous phone conferences， and much writing by the scientistson this committee who volunteered their time to work with thecomplexity of these issues. First and foremost， I want to acknowledgethem for their dedication and perseverance in working through theCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlxii PREFACEdiversity of issues and bringing to the discussion their depth ofexpertise in the diverse areas necessary for a report such as this.Second， I want to thank Linda Meyers， study director， for her leader-ship in helping all of us stay focused on the task at hand and forproviding support to our endeavor in so many ways. I especiallythank our expert consultant， Bernadette Marriott， for her vital con-tributions that were essential and critical to the completion of thereport. The committee appreciates the assistance of the Food andNutrition Board (FNB) staff in developing this report， particularlythat of Romy Gunther-Nathan for her contributions as the originalco-study director， Harleen Sethi for making our meetings and con-ference calls run so smoothly， Tazima Davis for her research assis-tance， Shannon Ruddy for assisting in the completion of the report，and Gail Spears for her technical editing. We wish to thank AllisonYates， former FNB Director， for her thoughtful interactions anddiscussions with the committee on some of the more difficult issues.The committee also benefited greatly from the statistical and com-puter skills of Craig Johnson. The committee held two workshops tobroaden its knowledge of the issues and to hear from interestedgroups. The committee acknowledges the following individuals fortheir insightful comments at these workshops： Susan Borra， MargaretCheney， Brenda Derby， Annette Dickinson， Robert Earl， ConstanceGeiger， Nancy Green， Suzie Harris， Regina Hildwine， Clifford L.Johnson， Allison Kretser， Bonnie Liebman， Alanna Moshfegh， IanMunro， Robert Post， Leila Saldanha， Christine Taylor， and KathrynWiemer. In particular， the committee thanks Margaret Cheney， RobertPost， and Virginia Wilkening and their colleagues for assisting itsresearch into the history and status of food labeling and fortification.This report is a derivative of the DRI reports and as such reflectsthe work of the Standing Committee on the Scientific Evaluation ofDietary Reference Intakes and its panels and subcommittees. Themultipart committee-panel structure that comprises the DRI processhas led to a series of reports involving over 100 expert scientists whohave rigorously maintained a consistent approach and understand-ing of the basic DRI definitions and derivations. While this report isoutside of the framework of review for the DRI reports， its essencehas benefited from the diligent work of those scientists.In this report the Committee on Use of Dietary Reference Intakesin Nutrition Labeling presents its recommendations as a series ofguiding principles to assist the regulatory agencies that oversee foodlabeling and fortification in the United States and Canada. Althoughthe committee members have varying levels of past experience withfood regulations in our respective countries， over the course of thisCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlPREFACE xiiistudy we have gained a deeper appreciation for the difficulty andcomplexity of the steps necessary to develop a nutrition label andthe policies of discretionary fortification that are truly helpful forthe broad population of consumers in our two countries. We pro-vide this guidance to FDA， FSIS， and Health Canada with the hopethat it will assist them in moving the process forward so that thesignificant science base in the DRIs can rapidly be used to benefitthe health of our nations.Irwin H. Rosenberg， ChairCommittee on Use of Dietary Reference Intakesin Nutrition LabelingCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlxvEXECUTIVE SUMMARY 11 INTRODUCTION 13Committee Charge and Study Process， 15Report Organization， 172 OVERVIEW OF NUTRITION LABELING IN THEUNITED STATES AND CANADA 18Reference Values and Nutrition Labeling in the UnitedStates， 18Reference Values and Nutrition Labeling in Canada， 35Consumer Understanding and Use of NutritionLabeling， 403 OVERVIEW OF FOOD FORTIFICATION IN THEUNITED STATES AND CANADA 45History and Current Status of U.S. Food FortificationPolicy， 45History and Current Status of Canadian Food FortificationPolicy， 52Summay， 554 A BRIEF REVIEW OF THE HISTORY AND CONCEPTSOF THE DIETARY REFERENCE INTAKES 56Origin， 56Rationale for the Framework， 58ContentsCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlxvi CONTENTSWhat Are Dietary Reference Intakes?， 60Categories of Dietary Reference Intakes， 61Dietary Reference Intake Issues Especially Relevant toNutrition Labeling and Discretionary Fortification， 74General Issues for Nutrition Labeling and DiscretionaryFortification， 785 GUIDING PRINCIPLES FOR SELECTING REFERENCEVALUES FOR NUTRITION LABELING 79Guidance on Developing Reference Values， 80Use of Tolerable Upper Intake Levels， 109Additional Issues， 1106 GUIDING PRINCIPLES FOR THE DISCRETIONARYADDITION OF NUTRIENTS TO FOOD 124Scientific Justification and Criteria， 126A Conceptual Model， 131Issues in Implementing a Level of DiscretionaryFortification， 1387 DATA SUPPORT AND RESEARCHRECOMMENDATIONS 145Research in Support of Determining NutrientRequirements， 146Biological Endpoints Underlying the Tolerable UpperIntake Levels and Information on Adverse Effects， 146Empirical Research to Ascertain the Impact ofDiscretionary Fortification， 147Food Composition and Dietary Supplement Databases， 148Changes in Nutrition Labeling and Consumer Researchon Its Use， 1498 REFERENCES 153APPENDIXESA Biographical Sketches of the Committee， 165B Selected Illustrative Calculations Using a Population-Weighted Approach， 172C Reference Tables， 179D Workshop Programs， 194INDEX 197Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlDRIDIETARY REFERENCE INTAKESGuiding Principles forNutrition Labeling andFortificationCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.html1Executive SummaryOVERVIEWAn old adage warns “You Are What You Eat!” In order for indi-viduals to test this adage， they must understand what they are eating.The Food and Drug Administration (FDA) first required nutritioninformation as part of food and dietary supplement labeling in 1941.As early as the 1950s， reports were published that informed con-sumers about the links between diet and health， specifically dietaryfat， cholesterol， and heart disease. The 1969 White House Confer-ence on Food， Nutrition， and Health set the stage for the 1973promulgation by FDA of the first comprehensive regulations fornutrition labeling. This was followed by the release of a number ofmajor government and professional association reports in the 1970son diet and health， including Dietary Goals for the United States (SenateSelect Committee on Nutrition and Human Needs， 1977). In thelate 1980s， with the publication of The Surgeon General’s Report onNutrition and Health (DHHS， 1988) and Diet and Health： Implicationsfor Reducing Chronic Disease Risk (NRC， 1989a)， the increasing scien-tific evidence on the links between diet and chronic disease riskcame to the forefront and brought even greater credence to the oldadage. In the early 1990s these two reports， along with NutritionLabeling： Issues and Directions for the 1990s (IOM， 1990) and other keyevents， such as the Nutrition Labeling and Education Act of 1990，led to changes in the nutrition information included on food labels.Specifically， FDA published new food labeling regulations that requiredthe Nutrition Facts box to be included on almost all food (FDA，Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.html2 DIETARY REFERENCE INTAKES1993a， 1993b， 1993c). The Nutrition Facts box and other mandatedlabel changes strengthened the label’s ability to serve as an impor-tant resource for helping consumers select food that could contrib-ute to a healthful diet.The current percent Daily Values (% DVs) that appear in theNutrition Facts box in the United States are based in part on rec-ommended reference values for nutrients from the 1968 Recom-mended Dietary Allowances (RDAs) (NRC， 1968). In Canada thenutrient information that appears on the label is based on the 1983Recommended Nutrient Intakes (RNIs) (Canada， 1983b).Since 1997 the Institute of Medicine has issued a series of nutri-ent reference values that are collectively termed Dietary ReferenceIntakes (DRIs) (IOM， 1997， 1998， 2000b， 2001， 2002a)， which includefour categories： the Estimated Average Requirement (EAR)， theAdequate Intake (AI)， the RDA， and the Tolerable Upper IntakeLevel (UL) (see Box ES-1). These reference values are replacementsfor the former RDAs in the United States and the RNIs in Canadaand as such represent a harmonization of the nutrient recommen-dations of the two countries. In addition to the DRIs， an AcceptableMacronutrient Distribution Range (AMDR) was developed formacronutrients.1As a result of the change in the concept for setting referencevalues for nutrients， the Committee on Use of Dietary ReferenceIntakes in Nutrition Labeling was convened to address a number ofquestions， including： Is the one reference value represented by% DV the most helpful approach for nutrition labeling for con-sumers? Is it best to derive one new reference value for nutritionlabeling for each nutrient or a set of values that address the diversityof needs for various life stage and gender groups? Which of thefour categories of DRIs must be incorporated into the basis for thenew food reference values? What approach should be taken to inte-grate the new DRIs into the concept of discretionary fortification offood? Is the same reference value approach used for labeling alsothe best scientific approach for discretionary fortification?This report focuses on how the DRIs， and the science for eachnutrient in the DRI reports， can be used to develop appropriatereference values for nutrition labeling. The primary scientificresources for this report are therefore the DRI reports (IOM， 1997，1An AMDR is a range of intakes for a particular energy source that is associatedwith reduced risk of chronic disease but also provides adequate intakes of essentialnutrients.Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlEXECUTIVE SUMMARY 3BOX ES-1 Dietary Reference IntakesRecommended Dietary Allowance (RDA)： the average daily dietary nutrient intakelevel sufficient to meet the nutrient requirement of nearly all (97 to 98percent) healthy individuals in a particular life stage and gender group.Adequate Intake (AI)： the recommended average daily intake level based onobserved or experimentally determined approximations or estimates ofnutrient intake by a group (or groups) of apparently healthy people that areassumed to be adequate—used when an RDA cannot be determined.Tolerable Upper Intake Level (UL)： the highest average daily nutrient intakelevel that is likely to pose no risk of adverse health effects to almost allindividuals in the general population. As intake increases above the UL， thepotential risk of adverse effects may increase.Estimated Average Requirement (EAR)： the average daily nutrient intake levelestimated to meet the requirement of half the healthy individuals in a partic-ular life stage and gender group.a___________________aIn the case of energy， an Estimated Energy Requirement (EER) is provided;it is the average dietary energy intake that is predicted to maintain energybalance in a healthy adult of a defined age， gender， weight， height， and levelof physical activity consistent with good health. In children and pregnantand lactating women， the EER is taken to include the needs associated withthe deposition of tissues or the secretion of milk at rates consistent withgood health.SOURCE： IOM (2002a).UL0.51.00.001.05RDAEARObserved Level of IntakeRisk of Inadequacy Risk of Adverse EffectsCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.html4 DIETARY REFERENCE INTAKES1998， 2000a， 2000b， 2001， 2002a， 2003). The overarching goal is tohave updated nutrition labeling that consumers can use to compareproducts and make informed food choices. The task of the commit-tee was to aid this effort by providing recommendations to thesponsoring agencies， in the form of guiding principles， on how bestto use the new DRIs and their underlying science in nutrition label-ing. In addition， the committee was requested to provide guidanceon incorporating the DRIs into approaches for discretionary fortifica-tion. In the United States mandatory fortification (usually calledenrichment) refers to the situation where a food product is labeledin a manner that purports to conform to the standard of identityfor the enriched version of the food. Discretionary fortificationrefers to all other forms of the addition of nutrients to food， includ-ing unenriched versions of products for which an enrichment stan-dard has been promulgated by FDA. In Canada the Food and DrugRegulations specify the foods to which micronutrients may be addedand the level at which they may be added. Throughout this reportthe general term “fortification” refers to the addition of nutrients tofood. The sponsors and primary audience for this study are the U.S.Department of Health and Human Services’ FDA， the U.S. Depart-ment of Agriculture’s Food Safety and Inspection Service (FSIS)， andHealth Canada.2GUIDING PRINCIPLES AND RECOMMENDATIONSGuiding Principles for Nutrition LabelingThe committee focused its analysis on the existing DRIs， the pur-pose of nutrition labeling， current labeling and fortification poli-cies， and the limited information on consumer use of food labels.The committee’s main recommendations are presented in the formof guiding principles for how to use the DRIs in nutrition labelingand discretionary fortification. Boxes ES-2 and ES-3 list the 16 guid-ing principles.In the first guiding principle the committee recommends thatnutrition information continue to be presented as percent Daily2Health Canada is the federal department responsible for helping the people ofCanada maintain and improve their health. In partnership with provincial andterritorial governments， Health Canada provides national leadership to develophealth policy， enforce health regulations， promote disease prevention， and en-hance healthy living for all Canadians (Health Canada， 2003).Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.htmlEXECUTIVE SUMMARY 5BOX ES-2 Guiding Principles for Nutrition Labeling1. Nutrition information in the Nutrition Facts box should continue to beexpressed as percent Daily Value (% DV).2. The Daily Values (DVs) should be based on a population-weightedreference value.3. A population-weighted Estimated Average Requirement (EAR) shouldbe the basis for DVs for those nutrients for which EARs have beenidentified.4. If no EAR has been set for a nutrient， then a population-weightedAdequate Intake (AI) should be used as the basis for the DV.5. The Acceptable Macronutrient Distribution Ranges (AMDRs) shouldbe the basis for the DVs for the macronutrients protein， total carbohy-drate， and total fat.6. Two thousand calories (2，000 kcal) should be used， when needed， asthe basis for expressing energy intake when developing DVs.7. The DVs for saturated fatty acids， trans fatty acids， and cholesterol shouldbe set at a level that is as low as possible in keeping with an achievablehealth-promoting diet.8. While the general population is best identified as all individuals 4 yearsof age and older， the committee recognized four distinctive life stagesduring which individuals’ nutrient needs are physiologically differentfrom the main population. These are： infancy， toddlers ages 1 to 3 years，pregnancy， and lactation. Development of DVs for these groups shouldbe guided by the following principles：Infants (<1 y)： one set of DVs based on the EARs or AIs of older infants(7–12 mo).Toddlers (1–3 y)： one set of DVs based on the EARs or AIs.Pregnancy： one set of DVs based on the population-weighted EARs or AIsfor all Dietary Reference Intake (DRI) pregnancy groups.Lactation： one set of DVs based on the population-weighted EARs or AIsfor all DRI lactation groups.9. The Supplement Facts box should use the same DVs as the NutritionFacts box.10. Absolute amounts should be included in the Nutrition Facts and Sup-plement Facts boxes for all nutrients.Copyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.html6 DIETARY REFERENCE INTAKESBOX ES-3 Guiding Principles for Discretionary Fortification11. The scientific justification for discretionary fortification of food shouldbe based on documented public health needs， particularly on dietaryinadequacy that is determined by assessing the prevalence of nutrientinadequacy in the population. Regulatory agencies should develop cri-teria for determining when the evidence of dietary inadequacy indicatesa documented public health need for the increased availability of nutri-ents in the food supply.12. In situations where discretionary fortification is scientifically justified，intake data should be used with the Tolerable Upper Intake Level (UL)to provide evidence， using a careful modeling approach， to explain howcurrent exposure to the nutrient in question would be altered by discre-tionary fortification.13. Currently there is limited research on the impact of discretionary fortifi-cation on the distribution of usual intakes in the population. Consider-ation should be given to fortification with nutrients up to the amountfor products to meet the criteria as “good” or “excellent” sources of thenutrients， consistent with the modeling approach described in GuidingPrinciple 12.14. Potential changes to certain long-standing discretionary fortificationpractices should be carefully reviewed because they may be central tothe maintenance of nutrient adequacy in the population.15. The severity of the adverse effect on which the UL is based should bereviewed when considering discretionary fortification with a nutrientusing the conceptual decision approach presented in Figure ES-1.16. Where discretionary fortification is scientifically justified for special-useproducts， the intended use of the targeted food should be the standardagainst which the nutrient content is assessed.Value (% DV). Guiding Principles 2 through 10 are grounded indeveloping reference values based on a population-weighted EAR，where available， as the foundation for the % DV. If there has beenno EAR set for a nutrient， the committee describes the use of theother reference values， specifically a population-weighted AI or anAMDR (see Chapter 5).The Nutrition Facts box has limited space and cannot accommo-date a large table of values， nor would such complexity be helpfulfor the consumer. Population-weighting is needed because the com-mittee recommends defining individuals 4 years of age and older asCopyright © National Academy of Sciences. All rights reserved.Dietary Reference Intakes： Guiding Principles for Nutrition Labeling and Fortificationhttp：//www.nap.edu/catalog/10872.html
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