Manual of Clinical Nutrition Management A- 1 Copyright © 2013 Compass Group, Inc.
STATEMENT ON NUTRITIONAL ADEQUACY
The Dietary Reference Intakes (DRIs) of the Food and Nutrition Board of the Institute of Medicine, National
Academy of Sciences, are used as the standard for determining the nutritional adequacy of the regular and
modified diets outlined in this manual. DRIs reference values that are quantity estimates of nutrient intakes to
be used for planning and assessing diets for healthy people. The DRIs consist of four reference intakes:
Recommended Daily Allowances (RDA), a reference to be used as a goal for the individual.
Tolerable Upper Intake Level (UL), the intake level given to assist in advising individuals of what intake
levels may result in adverse effects if habitually exceeded.
Estimated Average Requirement (EAR), the intake level which data indicates that the needs for 50% of
individuals consuming this intake will not be met.
Adequate Intake (AI), a recommended intake value for a group or groups of healthy people based on fewer
data and substantially more judgment than used in establishing an EAR and subsequently the RDA.
An AI is given when the RDA cannot be set. Both of these reference intakes are to be used as goals in
planning and assessing diets for healthy individuals (1,2). The DRIs do not cover special needs for nutrients
due to various disease conditions. DRIs are reference values appropriate for both assessing population
intakes and planning diets for healthy people (1,2).
When referring to energy, use Estimated Energy Intake (EER). EER is the average dietary energy intake
that is predicted to maintain energy balance in a healthy adult of a defined age, gender, weight, height and
level of physical activity, consistent with good health. For children, pregnant and lactating women, the EER
includes the needs associated with deposition of tissues or the secretion of milk at rates consistent with good
health ( 3 ).
The sample menus throughout this manual have been planned to provide the recommended DRIs for men,
31 to 50 years of age, unless indicated otherwise, and have been analyzed by a nutrient analysis software
program. For specific values, refer to the following tables of recommended DRIs from the Food and Nutrition
Board of the National Academy of Sciences. However, it is acknowledged that nutrient requirements vary
widely. The dietitian can establish an adequate intake on an individual basis.
Nutrient analysis of the menus is available from Webtrition and reflects available nutrient information.
Webtrition pulls nutrient information from either the USDA Standard Reference database (which includes 36
of the 41 RDA/DRI nutrients) or the manufactures information (manufactures are required only to provide 13
of the 41 RDA/DRI nutrients). Because of this, nutritional analysis data may be incomplete for some foods
and/or some nutrients that are listed in the DRI. The Menu Nutrient Analysis Report in Webtrition uses a (+)
to indicate a partial nutritional value and a (-) to indicate no nutritional value available.
The DRIs are provided in a series of reports (3-7). Full texts of reports are available at http://www.nap.edu.
References
- Yates AA, Schlicker SA, Suitor CW. Dietary Reference Intakes: The new basis for recommendations for calcium and related nutrients,
B vitamins, and choline. J Am Diet Assoc. 1998;98:699-706. - Trumbo P, Yates A, Schlicker S, Poos M. Dietary Reference Intakes: Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine,
Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. J Am Diet Assoc. 2001;101(3):294-301. - Institute of Medicine’s Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids,
Cholesterol, Protein, and Amino Acids. (Macronutrients). Washington, DC: National Academy of Sciences, 2005: 107-180. - Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Food and Nutrition
Board, Washington, DC: National Academy Press;1997. - Institute of Medicine. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid,
Biotin, and Choline. Food and Nutrition Board, Washington, DC: National Academy Press;1998. - Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Cartotenoids. Food and Nutrition Board,
Washington, DC: National Academy Press;2000. - Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Molybdenum,
Nickel, Silicon, Vandium and Zinc. Food and Nutrition Board. Washington, DC: National Academy Press; 2001.