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Traditional and chronic disease endpoints for DRIs 1

Traditional and chronic disease endpoints for DRIs 1

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Article
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Dietary Reference Intakes (DRIs) are used in Canada and the United States in planning and assessing diets of apparently healthy individuals and population groups. The approaches used to establish DRIs on the basis of classical nutrient deficiencies and/or toxicities have worked well. However, it has proved to be more challenging to base DRI values...

Contexts in source publication

Context 1
... is useful to compare the reference value concepts tradi- tionally used for nutrient requirements and toxicities with the concepts that pertain to chronic disease risk reduction ( Table 4). [Intakes of "beneficial" substances ...
Context 2
... vary in the type of outcome measured, ranging from direct measures of the chronic disease based on generally ac- cepted diagnostic criteria to indirect assessment by using either a qualified surrogate marker of the chronic disease outcome or a nonqualified disease marker ( Figure 2) (15). Guidance on se- lection of an indicator based on a chronic disease outcome would inform decisions as to whether newer types of DRI values specifically focused on chronic disease outcomes are more ap- propriate than are more traditional reference values (Table 4) (see section VI on intake-response relations). In addition, it would clarify applications for some major users of DRIs (e.g., regulatory, policy) for whom clear differentiation between chronic disease and functional endpoints is important for legal and pro- grammatic purposes. ...
Context 3
... committees have based DRIs on the intakes necessary to avoid classical nutritional deficiencies (i.e., EARs and RDAs) and unsafe intakes associated with toxicities or adverse events (i.e., ULs) ( Figure 4, Table 1). Intake-response relations be- tween traditional endpoints for nutrient requirements (i.e., de- ficiency diseases) and adverse events are often different from those between food substances and chronic disease endpoints ( Table 4). ...
Context 4
... option is to continue considering chronic disease end- points in future DRI reviews but to expand the types of reference values to clearly distinguish those based on classical nutrient adequacy from those based on chronic disease endpoints ( Table 4). This option makes the addition of CD XX (where XX denotes the specific chronic disease) and UL CD values or ranges a natural extension of the current process. ...

Citations

... In empirical studies, the criteria used to determine misinformation often include diverse sources of evidence, such as peer-reviewed journal articles (Deshpande, Deshpande, and O'Brien 2018, 562), factchecking web sites (Safarnejad et al. 2020, 341), and the latest guidelines from health agencies such as the WHO and the CDC (Obiała et al. 2020, 2). To foster evidence-based practices in health settings, researchers proposed the hierarchy of evidence pyramid (Brownson, Fielding, and Maylahn 2009;Evans 2003;Murad et al. 2016;Yetley et al., 2017), suggesting that systematic reviews and meta-analyses of randomized controlled trials (RCTs) rank as the highest quality of evidence, followed by RCTs, cohort studies, case-control studies, cross-sectional studies, case reports, and expert opinions. Depending on the highest level of evidence available, there will be a degree of confidence in categorizing a claim of fact as false. ...
Preprint
In light of the ongoing debate about the nature of misinformation and the urgent need for a clear definition of health misinformation, this chapter aims to critically review current definitions of health misinformation, identify key challenges in defining health misinformation, and finally propose a tentative, unifying definition of health misinformation to guide future research. We conclude bydiscussing directions for future efforts in refining the definition for health misinformation.
... Publications that reported results from multiple studies were disaggregated and classified as separate studies, and multiple publications from the same study were aggregated in order to determine the number of relevant studies (as opposed to the number of publications). These included studies that provided two different types of analyses [e.g., data from a RCT reported in two publications, data from a baseline and follow-up from the same longitudinal cohort]; the study was classified under the study design type of strongest quality of evidence (31) A list of relevant systematic reviews and meta-analyses identified in the literature search was tabulated. These publications were not analyzed further in the current evidence map, because each of these systematic reviews addressed relevant but different research questions, including different population, intervention/exposure, and comparator. ...
Article
Background: Numerous governmental and health organizations recommend reduced intake of added sugars due to the health risks associated with excess intake, including the risk of obesity. Some organizations further recommend avoiding dietary sweetness, regardless of the source. Objective: A scoping review and evidence map were completed to characterize the research investigating dietary sweetness and body weight. The aim was to identify and map studies that investigate total dietary sweetness, sweet food/beverage, sugar, or sweetener intake and body weight-related outcomes and/or energy intake. Design: Using pre-registered search terms (osf.io/my7pb), 36,779 publications (duplicates removed) from PubMed, Cochrane Library, and Scopus were identified and screened for inclusion. Eligible studies were clinical trials, longitudinal cohorts, case-control studies, cross-sectional studies, and systematic reviews conducted among adults (≥18 years) which investigated associations between dietary sweetness, sweet food/beverage, sugar, or sweetener (energetic or non-energetic) intake and body weight, body mass index, adiposity, and/or energy intake. Results: A total of 833 eligible publications were identified, detailing 804 studies. Only 7 studies (0.9% of included studies) (2 clinical trials, 4 cross-sectional studies, 1 other design type) investigated associations between total dietary sweetness and a body weight-related outcome and/or energy intake. An additional 608 (75.6%) studies investigated sweet food/beverage, sugar, or sweetener intake and body weight-related outcomes and/or energy intake, including 225 clinical trials, 81 longitudinal cohorts, 4 case-control studies, and 280 cross-sectional studies. Most studies (90.6%) did not measure the sweetness of the diet or individual foods consumed. Ninety-two (11.4%) publications reported on dietary patterns that included sweet foods/beverages alongside other dietary components and 97 (12.1%) systematic reviews addressed different but related research questions. Conclusions: While there is a breadth of evidence from studies that investigate sweet food/beverage, sugar, and sweetener intake and body weight, there is limited evidence on the association between total dietary sweetness and body weight.
... In the scoping review, we found that dose-response randomised controlled trials (RCTs) that assessed the effects of vitamin D intake on agespecific clinical outcomes of public health importance were scarce. According to the generic analytic framework ( Figure 1) [10], when evidence of the association between exposure and clinical outcomes of interest is lacking ( Figure 1, Arrow 1), a "piecemeal approach" (also known as the "dose-response approach" [11]) that uses indicators of exposure (Arrow 4) and surrogate outcomes (Arrow 5) has been suggested as an option for setting NRVs [12]. Therefore, the FAO/WHO expert group determined that a dose-response approach would be appropriate for setting vitamin D requirements for the target age group. ...
Article
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BACKGROUND A systematic review was commissioned to support an international expert group charged to update the Food and Agriculture Organisation of the United Nations (FAO)/World Health Organisation (WHO)’s vitamin D intake recommendations for children aged 0–4 years. MATERIALS AND METHODS Multiple electronic databases were searched to capture studies published from database inception to the 2nd week of June 2020 according to key questions formulated by the FAO/WHO. Relevant studies were summarised and synthesised by key questions and by health outcomes using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. RESULTS The 146 included studies examined the effects of different vitamin D intake levels on a variety of health outcomes (e.g. infectious disease, growth, neurodevelopment, rickets, and bone mineral density), and on outcomes for setting vitamin D upper limits (e.g. hypercalcemia, hypercalciuria, and nephrocalcinosis). For most outcomes, the strength of evidence was low or very low. Evidence was rated moderate for the effect of daily vitamin D supplementation on raising serum 25(OH)D concentrations, and a random-effects meta-regression analysis of 28 randomised controlled trials (mostly in infants 0–12 months) showed that each 100 IU/d increase in vitamin D supplementation was associated with an average of 1.92 (95% CI 0.28, 3.56) nmol/L increase in achieved 25-hydroxy-vitaminn D (25[OH]D) concentration (n = 53 intervention arms; p = .022) with large residual heterogeneity (I2 = 99.39%). Evidence was very low on two of the upper limit outcomes – hypercalcemia and hypercalciuria. CONCLUSIONS The evidence report provided the expert group with a foundation and core set of data to begin their work to set vitamin D nutrient reference values. To move the field forward, future studies should use standardised 25(OH)D assay measurements and should examine the relationship between long-term vitamin D status and health outcomes.
... Acham et al. reviewed the benefits of tropical fruits in the prevention of chronic diseases [4]. Yetley et al. believed that DRI can evaluate dietary health [5]. eir efficiency in the prevention and management of chronic diseases is not very high, so we refer to relevant literature and use the K-means algorithm to optimize the prevention and treatment of chronic diseases. ...
Article
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Chronic diseases, also known as chronic noncommunicable diseases, have the characteristics of a long period of symptoms, complex and diverse causes, relatively large damage to human health, and a relatively wide impact on the overall safety of society. This study mainly discusses the application of exercise prescription formulation based on K-means algorithm in the prevention and treatment of chronic diseases. Aiming at different groups of people with different physical conditions in different environments, this study established a comprehensive exercise prescription library and feedback channels. By comparing and analyzing the effects of different exercise exercises, people can provide scientifically standardized and suitable exercise and fitness programs for people with chronic diseases. The feasibility of the K-means algorithm in chronic disease prediction is confirmed by experiments, and the experimental time of the improved algorithm and the traditional algorithm is compared, and the efficiency of the improved algorithm is confirmed. Aiming at the privacy, complexity, missing data values, and other issues of chronic disease medical examination data, we have carried out perfect data preprocessing research. After 12 weeks of exercise intervention, the vital capacity of the exercise group increased significantly (5.83%) ( P < 0.01 ). The subendocardial myocardial viability rate increased by 9.74% ( P < 0.01 ), and the radial artery reflected wave growth index and systolic blood pressure decreased slightly ( P < 0.05 ). This indicates that the 12-week exercise training intervention program designed in this study can effectively enhance the cardiopulmonary function of the exercise group, thereby further improving the body’s aerobic capacity ( P < 0.05 ). This study lays the foundation for the smooth development of chronic disease prevention and treatment.
... In countries with programs to fortify their food supplies compared to others, the likelihood of excessive nutrient intake via dietary supplements is higher, so they must also be taken into consideration [132][133][134][135]. It is frequently difficult to establish safe intake amounts of non-nutrient bioactives in supplements due to a lack of dose-response evidence [136,137]. Even after accounting for concurrent use with acetaminophen and alcohol as well as consumption while fasting, some dietary supplements with non-target herbs added purposefully (such as germander as an adulterant for skullcap) or accidentally (such as black cohosh, kava extract, green tea, and others) have been connected to various types of liver damage [138]. ...
Article
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Neuropathologies, such as neuroinflammaging, have arisen as a serious concern for preserving the quality of life due to the global increase in neurodegenerative illnesses. Nowadays, neuronutraceuticals have gained remarkable attention. It is necessary to investigate the bioavailability, off-target effects, and mechanism of action of neuronutraceuticals. To comprehend the comprehensive impact on brain health, well-designed randomized controlled trials testing combinations of neuronutraceuticals are also necessary. Although there is a translational gap between basic and clinical research, the present knowledge of the molecular perspectives of neuroinflammaging and neuronutraceuticals may be able to slow down brain aging and to enhance cognitive performance. The present review also highlights the key emergent issues, such as regulatory and scientific concerns of neuronutraceuticals, including bioavailability, formulation, blood–brain permeability, safety, and efficacy.
... The DRI values are a broad group of reference values that serve as the foundation for monitoring the nutritional status of individuals and populations, developing dietary guidelines, and establishing standards for federally funded nutrition programs for what are termed generally healthy individuals in the United States and Canada (1)(2)(3)(4)(5)(6)(7)(8)(9). The most recent re-evaluation of DRI values (for calcium, vitamin D, sodium, and potassium) have included the use of systematic reviews (10)(11)(12)(13). In addition, the recent updates of sodium and potassium DRIs include a new chronic disease risk reduction (CDRR) category that recognizes the role of nutrients beyond the prevention of nutrient deficiency disorders. ...
... In addition, the recent updates of sodium and potassium DRIs include a new chronic disease risk reduction (CDRR) category that recognizes the role of nutrients beyond the prevention of nutrient deficiency disorders. Inclusion of the CDRR is important given the prevalence of diet-related chronic disease in the United States (14), and highlights the importance of updating the DRIs to include this information when it is relevant for the public health impact of the DRI values (11,13). The use of systematic reviews for the DRI re-evaluation process is intended to facilitate the work of the nutrient review committee of the Food and Nutrition Board (FNB) and ensure a comprehensive and unbiased approach (15). ...
Article
Introduction The DRI values are a broad group of reference values that serve as the foundation for monitoring the nutritional status of individuals and populations, developing dietary guidelines, and establishing standards for federally funded nutrition programs for what are termed generally healthy individuals in the United States and Canada (1–9). The most recent re-evaluation of DRI values (for calcium, vitamin D, sodium, and potassium) have included the use of systematic reviews (10–13). In addition, the recent updates of sodium and potassium DRIs include a new chronic disease risk reduction (CDRR) category that recognizes the role of nutrients beyond the prevention of nutrient deficiency disorders. Inclusion of the CDRR is important given the prevalence of diet-related chronic disease in the United States (14), and highlights the importance of updating the DRIs to include this information when it is relevant for the public health impact of the DRI values (11, 13). The use of systematic reviews for the DRI re-evaluation process is intended to facilitate the work of the nutrient review committee of the Food and Nutrition Board (FNB) and ensure a comprehensive and unbiased approach (15). A limitation to this approach is that systematic reviews are resource intensive and, hence, may not be feasible for all 51 essential nutrients and food components (16).
... As a result, the contributions of each article were also assessed in accordance with the hierarchy of evidence. 16 The categorisation of these articles are detailed in table 2. ...
Article
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Objectives The National Health Service has been moving towards integrated care for the best part of two decades to address the growing financial and service pressures created by an ageing population. Integrated healthcare systems (IHSs) join up health and social care services and have been established to manage the care of individuals with complex chronic conditions but with varied success. It is therefore imperative to conduct a Systematic Literature Review (SLR) to identify and understand the factors that influence their successful functioning, and ascertain the factor with the greatest influence, in order to ensure positive outcomes when establishing future IHSs. Methods Articles published between 1 January 1997 and 8 March 2020 were analysed from the following six databases: Healthcare Management Information Consortium, Nuffield Trust, Cumulative Index to Nursing and Allied Health Literature, PubMed, National Institute for Health and Care Excellence Evidence and Health Systems Evidence. Those deemed relevant after title and abstract screening were procured for subsequent review of the full-text article. Results Thirty-three finalised articles were analysed in this SLR to provide a comprehensive overview of the factors that influence the functioning of IHSs. Factors were stratified into six key categories: organisational culture, workforce management, interorganisational collaboration, leadership ability of staff, economic factors and political factors. Leadership was deemed to be the most influential factor due to its intrinsic and instrumental role in influencing the other key factors. Conclusions The findings of this SLR may serve as a guide to developing tailor-made recommendations and policies that address the identified key factors and thereby improve the functioning of present and future IHSs. Furthermore, due to both its overarching influence and the inadequacy of literature in this field, there is a strong case for further research exploring leadership development specifically for IHSs.
... The quality of the evidence of the included studies was assessed using the National Institutes of Health study quality assessment tool [31], with each rated "good", "fair", or "poor". While this approach accounted for intra-design variability in quality, we also considered inter-design quality, using a rating scheme adapted from Yetley et al. (2016) [32] that ranked study designs from highest to lowest, as follows: controlled intervention study, cohort study, case-control study, pre-post evaluation, crosssectional study, and case study. These qualitative scores were taken into consideration at the data synthesis stage to help gauge the quality and strength of the evidence. ...
Article
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Background Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare, guidance on NPI implementation rarely takes the specific needs of such populations into account. We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settlements. Methods We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire. We analysed the data to produce descriptive summaries according to a number of categories: date of publication; geographical region of intervention; typology of crisis, shelter, modes of transmission, NPI, research design; study design; and study quality. Results Our review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable, despite apparent effectiveness. Conclusions Overall, the evidence base was variable, with substantial knowledge gaps which varied between settings and pathogens. Based on the current landscape, robust evidence-based guidance is not possible, and a research agenda is urgently required that focusses on these specific vulnerable populations. Although implementation of NPIs presents unique practical challenges in these settings, it is critical that such an agenda is put in place, and that the lessons learned from historical and present experiences are documented to build a firm evidence base. Graphical Abstract
... DRIs of potassium (K), sodium (Na), fiber, and vitamin E were set based on AI, which is the recommended average daily nutrient intake level based on experimentallyederived intake levels or approximations of observed mean nutrient intake by a group (or groups) of apparently healthy people that are assumed to be adequate [20]. DRI of cholesterol was set as based on chronic disease endpoints that are reference values for intakes that affected chronic disease outcomes [21]. The DRIs of other nutrients were set based on recommended nutrient intake (RNI), which is the average daily level of nutrient intake sufficient to meet the nutrient requirements of approximately all (97%e98%) healthy people. ...
Article
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Background Comprehensive understanding of gene-diet interactions is necessary to establish proper dietary guidelines to prevent and manage general and abdominal obesity. We investigated the role of genetic variants and their interactions with general and abdominal obesity–associated nutrients using a largescale genome-wide association study of Korean adults. Methods A total of 50,808 participants from a Korean genome and epidemiology study were included. Dietary intake was assessed using a food frequency questionnaire. Obesity was defined as a body mass index ≥25 kg/m². Abdominal obesity was defined as waist circumference ≥90 cm and 80 cm in males and females, respectively. Dietary nutrient intake was classified based on Korean Dietary Reference Intakes (DRIs). Odds ratios and 95% confidence intervals were calculated after adjusting for age, sex, exercise, smoking, alcohol drinking, total energy consumption, PC1, and PC2. Results Among the individuals consuming fat (%) above DRI, carriers of Ca binding protein 39 (CAB39)- rs6722579 minor allele (A) have a higher risk of AO than those not carrying the SNP (odds ration [OR]=3.73, p-value=2.05e-07; interaction p-value=1.80e-07). Among the individuals consuming vitamin C above DRI, carriers of carboxypeptidase Q (CPQ)- rs59465035 minor allele (T) have a lower risk of AO than those without that SNP (OR=0.89, p-value=1.44e-08; interaction p-value=9.50e-06). The genetic association with obesity was stronger among individuals with a genetic variant rs4130113 near GHR gene region in those consume folate above DRI and with a genetic variant rs5760920 near CRYBB2 gene region in those consume vitamin B2 above DRI. Conclusion Our study results suggested that interactions of specific polymorphisms at loci and certain nutrients may influence obesity and abdominal obesity.
... Scientific consensus committees tasked with evaluating diet and health-disease relations for policy, clinical, and educational purposes are increasingly applying evidence-based methodologies to the evaluation of nutrition studies (1). However, a universal observation is that although the concepts and methods of evidence-based medicine are applicable to nutrition topics, diet-related challenges in nutrition studies require consideration (1)(2)(3)(4)(5)(6)(7). ...
... Scientific consensus committees tasked with evaluating diet and health-disease relations for policy, clinical, and educational purposes are increasingly applying evidence-based methodologies to the evaluation of nutrition studies (1). However, a universal observation is that although the concepts and methods of evidence-based medicine are applicable to nutrition topics, diet-related challenges in nutrition studies require consideration (1)(2)(3)(4)(5)(6)(7). These include the difficulty in obtaining accurate and comprehensive exposure estimates (i.e., intake or status estimates), the potential for confounding and interactive effects of food substances, and the impact of participant baseline nutritional status on the relation between exposure to a particular food substance and health outcome. ...
... The first issue identified was the challenge involved in obtaining accurate estimates of exposure and status-an issue that has received considerable attention (1,4,5,17,44,45,47). Several authoritative reports have offered guidance on how to deal with these issues in reporting and evaluating study RoB, and in analyzing study results (4,5,17,19,34). ...
Article
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Background Dietary exposure assessments are a critical issue in evaluating human nutrition studies; however, nutrition-specific criteria are not consistently included in existing bias assessment tools. Objective Our objective was to develop a set of Risk of Bias (RoB) tools that integrated nutrition-specific criteria into validated generic assessment tools to address RoB issues, including those specific to dietary exposure assessment. Methods Nutrition QUality Evaluation Strengthening Tools (NUQUEST) development and validation process included eight steps. The first steps identified: 1) a development strategy; 2) generic assessment tools with demonstrated validity; and 3) nutrition-specific appraisal issues. This was followed by: 4) generation of nutrition-specific items, and 5) development of guidance to aid users of NUQUEST. The final steps used established ratings of selected studies and feedback from independent raters to: 6) assess reliability and validity; 7) assess formatting and usability; and 8) finalize NUQUEST. Results NUQUEST is based on the Scottish Intercollegiate Guidelines Network checklists for randomized controlled trials, cohort studies and case-control studies. Using a purposive sample of 45 studies representing the three study designs, inter-rater reliability was high (Cohen's kappa 0.73, 95% confidence interval (CI) 0.52, 0.93) across all tools and at least moderate for individual tools (range 0.57 to 1.00). The use of a worksheet improved usability and consistency of overall inter-rater agreement across all study designs (40% without worksheet, 80–100% with worksheet). When compared to published ratings, NUQUEST ratings for evaluated studies demonstrated high concurrent validity (93% perfect or near-perfect agreement). Where there was disagreement, the nutrition-specific component was a contributing factor in discerning exposure methodological issues. Conclusion NUQUEST integrates nutrition-specific criteria with generic criteria from assessment tools with demonstrated reliability and validity. NUQUEST represents a consistent and transparent approach for evaluating RoB issues related to dietary exposure assessment commonly encountered in human nutrition studies.