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Disorders of Nutritional Status
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Dietary Reference Intakes
The Dietary Reference Intakes (DRIs) are a set of ref-
erence values that identify the level of nutrient intake
an individual needs to maintain health and decrease the
risk for disease.
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They are published by the National
Academy of Sciences and are periodically reviewed
and updated by the Institute of Medicine’s Food and
Nutrition Board. A complete database of the DRIs is
available online through the United States Department
of Agriculture Food and Nutrition Information Center.
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The DRIs are a set of reference values that identify
the recommended estimated average requirement, dietary
allowance, adequate intake, tolerable upper intake
level, and acceptable macronutrient distribution range,
each of which has specific uses.
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An Estimated Average
Requirement (EAR) is the intake that meets the esti-
mated nutrient need of half of the persons in a specific
group. This figure is used as the basis for developing the
Recommended Dietary Allowance (RDA), which defines
the nutrient intakes that meet the needs of almost all
healthy persons in a specific age and sex group.
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The
Adequate Intake (AI) is set when there is not enough sci-
entific evidence to derive an EAR and therefore the RDA.
The AI is derived from experimental or observational
data that show a mean intake that appears to sustain a
desired indicator of health. The Tolerable Upper Intake
Level (UL) is the maximum intake that is judged unlikely
to pose a health risk in almost all healthy persons in a
specified group. It refers to the total intake from food,
fortified food, and nutrient supplements. This value is
not intended to be a recommended level of intake, and
there is no established benefit for persons who consume
nutrients above the RDA or AI levels. The Acceptable
Macronutrient Distribution Range (AMDR) is a percent-
age of energy intake for carbohydrates, proteins, and fats,
including the linoleic and
α
-linolenic essential fatty acids,
that is associated with good health. For example, the
AMDR for protein is 10% to 35%; that is, no less than
10% and no more than 35% of the total energy (calorie)
intake should come from proteins. Finally, the DRI for
total energy is the estimated energy requirement (EER).
Food and supplement labels use the percent
Daily
Value
(%DV), which is set by the Food and Drug
Administration (FDA). The
%DV
tells the consumer
what percent of an individual’s daily need for a given
nutrient one serving of a food or supplement supplies.
Because individuals of different age and sex have differ-
ent nutrient needs, the percent of DV is intended to be
used as an example. It is based on a 2,000-calorie diet.
Calories
Energy requirements are greater during growth peri-
ods. Infants require approximately 115 kcal/kg of body
weight at birth, 105 kcal/kg at 1 year of age, and 80 kcal/kg
between 1 and 10 years of age. During adolescence,
boys require 45 kcal/kg of body weight and girls require
38 kcal/kg. During pregnancy, a woman needs an extra
300 kcal/day above her usual requirement, and dur-
ing the first 3 months of breast-feeding, she requires an
additional 500 kcal.
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Table 10-1 identifies the EER for
healthy adults.
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Proteins, Fats, and Carbohydrates
Proteins, fats, and carbohydrates yield energy. They are
referred to as macronutrients because the body requires
them in relatively large amounts.
Proteins.
Proteins are required for growth and mainte-
nance of body tissues, enzymes and antibody formation,
fluid and electrolyte balance, and nutrient transport.
Proteins are composed of amino acids, nine of which
TABLE 10-1
Estimated Energy Requirements (EER) at Different Activity Levels for Men andWomen
30Years of AgeWith a Normal (<25), Overweight (25 to 29.9), and Obese (
≥
30) BMI
BMI
Height m (in.)
Weight kg (lb)
Activity Level
*
EER (kcal/d) Male EER (kcal/d) Female
22.1
1.75
68
Rarely
2404
2055
Normal
(69)
(150)
Low activity
2627
2285
Active
2911
2571
Very active
3378
2915
26.5
1.75
77
Rarely
2620
2140
Overweight
(69)
(170)
Low activity
2867
2380
Active
3182
2679
Very active
3698
3038
31
1.75
95
Rarely
2837
2310
Obese
(69)
(210)
Low activity
3108
2570
Active
3452
2894
Very active
4018
3284
*Activity level definitions:
Sedentary = rarely exercises
Low active = less 1 hour/day
Active = about 1 hour/day
Very active = more than 1 hour/day
Developed using “Adult Energy Needs and BMI Calculator” from USDA/ARS Children’s Nutrition Center at
Baylor College of Medicine. Available:
. Accessed September 6, 2013.
