Nutritions

                The dietary requirement for a micronutrient is defined as an intake level which meets a specified criteria for adequacy, thereby minimizing risk of nutrient deficit or excess. 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. However, for nutrients where insufficient data on mortality are available, which is the case for most micronutrients discussed in this report, other biological responses must Be defined. These include clinical disease as determined by signs and symptoms of nutrient deficiency, and subclinical conditions identified by specific biochemical and functional measures. Measures of nutrient stores or critical tissue pools may also be used to determine nutrient adequacy.

 

             Functional assays are presently the most relevant indices of subclinical conditions related to vitamin and mineral intakes. Ideally, these biomarkers should be sensitive to changes in nutritional state while at the same time be specific to the nutrient responsible for the subclinical deficiency. Often, the most sensitive indicators are not the most specific; for example, plasma ferritin, a sensitive indicator of iron status, may change not only in response to iron supply, but also as a result of acute infection or chronic inflammatory processes. Similarly anaemia, the defining marker of dietary iron deficiency, May also result from, among other things, deficiencies in folate, vitamin B or copper. The choice of criteria used to define requirements is of critical importance,

                  Since the recommended nutrient intake to meet the defined requirement will clearly vary, depending, among other factors, on the criterion used to define nutrient adequacy . Unfortunately, the information base to scientifically support the definition of nutritional needs across age ranges, sex and physiologic states is limited for many nutrients. Where relevant and possible, requirement estimates presented here include an allowance for variations in micronutrient bioavailability and utilization. The use of nutrient balance to define requirements has been avoided whenever possible, since it is now generally recognized that balance can be reached over a wide range of nutrient intakes. However, requirement levels defined using nutrient balance have been used if no other suitable data are available. The traditional criteria to define 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 consequence of, specific biochemical or functional changes that can be reversed by the presence of the essential dietary component. 

              Endpoints considered in recent investigations of essentiality of nutrients in experimental animals and humans include: reductions in ponderal or linear growth rates, altered body composition, compromised host defense systems, impairment of gastrointestinal or immune function, abnormal cognitive performance,  increased susceptibility to disease, increased morbidity and changes in biochemical measures of nutrient status. To establish such criteria for particular vitamins and minerals requires a solid understanding of the biological effects of specific nutrients, as well as sensitive instrumentation to measure the effects, and a full and precise knowledge of the amount and chemical form of nutrients supplied by various foods and their interactions.

 

              Nutrient balance calculations typically involve assessing input and output and establishing 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 influenced by prior level of intake, that is, subjects adjust to high intakes by increasing output and, conversely, they lower output when intake is low. Thus, if sufficient time is provided to accommodate to a given level of intake, balance can be achieved, and for this reason, the exclusive use of nutrient balance to define requirements should be avoided whenever possible . In the absence of alternative sources of data, a starting point in defining nutritional requirements using the balance methodology is the use of factorial estimates of nutritional need.

 

           The “factorial model” is based on measuring the components that must be replaced when the intake of a specific Nutrient is minimal or nil. This is the minimum possible requirement value And encompasses a) replacement of losses from excretion and utilization at Low or no intake, b) the need to maintain body stores and, c) an intake that Is usually sufficient to prevent clinical deficiency. Factorial methods should be used only as a first approximation for the assessment of individual requirements, or when functional clinical or biochemical criteria of adequacy have not been established. Furthermore, although nutrient balance studies may be of help in defining mineral needs, they are of little use for defining Vitamin requirements . This is because the carbon dioxide formed on the oxidation of vitamins is lost in expired air or hard to quantify, since it becomes part of the body pool and cannot be traced to its origin unless the vitamin is provided in an isotopically labelled form .

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