Robert D. Baker and Susan S. Baker
optimal growth and to avoid future nutrition-related complications, not merely to avoid defi ciency states.
NUTRITIONAL NEEDS AND REQUIREMENTS
Recommended Dietary Allowances (RDAs) were fi rst established in 1941 and fi rst published in 1943. The RDAs were based on scientifi c evidence and intended to serve as goals for good nutrition. Over the years the RDAs have changed according to the needs of the coun- try. When fi rst devised, the country was struggling with war-time shortages and the RDAs were used to guide priorities and to avoid widespread defi ciencies in groups of people. Over time, the emphasis changed to goals for individuals. The eighth edition of the RDAs published in 1974 included the following defi nition of RDA: “the levels of essential nutrients that, on the basis of scien- tifi c knowledge, are judged by the Food and Nutrition Board to be adequate to meet the known nutrient needs of practically all healthy persons.” The exception to the
“practically all healthy persons” rule is the RDA for energy. Since it would not be reasonable to recommend the high end of the distribution curve for energy, in this case the RDA was set at approximately the average.
Planning for the present Dietary Reference Intakes (DRIs), that have superseded the RDAs, began in 1993 with the realization that RDAs need to be “continu- ously” updated rather than periodically reviewed and updated and that values beyond RDAs were necessary.
Among other things, Upper Limits (UL) needed to be established. The DRIs are now the accepted reference standard for most nutrient requirements for all age groups. There is now a standing committee of the
NUTRITION IN HEALTH
According to the American Academy of Pediatrics, the goal of pediatrics is “to attain optimal physical, mental, and social health and well-being for all infants, chil- dren, adolescents, and young adults.” It is self-evident that maintaining good nutrition is a prerequisite to attaining this goal. Appropriate nutrition supplies the
“building blocks” for healthy physical growth. Optimal mental health and mental capacity rely on adequate nutrition, from conception to old age. D.J.P. Barker theorized that fetal nutrition is associated with a num- ber of chronic conditions of later life. The Barker hypothesis, in its expanded form, proposes that infant nutrition, as well as fetal nutrition, has long-term health effects reaching into adulthood and old age. Some of the parameters that may be affected by nutrition in infancy include cardiovascular health, blood pressure, bone mineralization, low-density lipoprotein choles- terol, split proinsulin, and cognitive development.
While these observations are tantalizing, they are obser- vational. A causal relationship has not been established.
The Barker hypothesis continues to be debated, but to the extent that it proves true, early nutrition gains tre- mendous importance.
Much of the early work on establishing nutritional requirements focused on preventing diseases and defi - ciencies. It was assumed that if a child were given ade- quate amounts and varieties of foods, good nutrition would automatically follow. The present obesity epidemic that has affected all age groups in our society has proven this assumption incorrect. It has become clear that we need to monitor the nutritional health of our youth and encourage good nutrition for all. In order to accomplish this, we must know the nutritional requirements for
books can be purchased or are available free online at www.USDA.gov. Table 8–1 lists and defi nes the refer- ence values included in the DRIs. As with earlier ver- sions, the DRIs list energy requirements (Table 8–2) at Institute of Medicine (IOM) that sets DRIs as directed
by the Food and Nutrition Board (FNB). The IOM has published these references in a series of eight volumes that cover more than 40 nutrient substances.1 These
Dietary Reference Intakes
Term Defi nition
Estimated Average Requirement (EAR)
The average daily intake level of a nutrient that, based on scientifi c evidence, is estimated to meet the requirements of half the healthy individuals of a particular gender and in a particular age group Recommended Dietary
Allowance (RDA)
The average daily nutrient intake level that meets the nutrient requirement of nearly all healthy individuals of a particular gender and in a particular age group. Usually the RDA is the EAR plus two standard deviations
Adequate Intake (AI) The recommended average intake level based on experimental or observed approximations or estimates of apparently adequate nutrient intakes by groups of individuals assumed to be healthy. AI is used when there is insuffi cient scientifi c knowledge to establish an EAR and therefore no RDA can be calculated
Tolerable Upper Intake Level (UL)
The highest average daily intake level of a nutrient that is likely to pose no risk of adverse health outcome to almost all individuals of a particular gender and in a particular age group Acceptable Macronutrient
Distribution Range (AMDR)
Range of macronutrient intakes for a particular energy source that is associated with reduced risk of chronic disease while providing adequate intakes of essential nutrients
Table 8–1.
Dietary Reference Intakes
Nutrient Age RDA AI UL
Carbohydrate (g/day): total digestible;
acceptable macronutrient distribution range: 45–65
0–6 months 130 60 Sugarsⱕ25% of
calories
7–12 months 130 95
1–3 years 130
4–8 years 130
9–13 years 14–18 years
Total fi ber (g/day) 0–6 months ND 19
7–12 months ND 25
1–3 years 31 (m), 26 (f )*
4–8 years 38 (m), 26 (f )
9–13 years 14–18 years
Total fat (g/day) 0–6 months 30–40 31
7–12 months 25–35 30
13 years 4–8 years 9–13 years 14–18 years
n-6 PUFAs (g/day) (linoleic acid) 0–6 months ND 4.4
7–12 months ND 4.6
1–3 years 7
4–8 years 10
9–13 years 12 (m), 10 (f )
14–18 years 16 (m), 11 (f )
Table 8–2.
Dietary Reference Intakes
Nutrient Age RDA AI UL
n-3 PUFAs (g/day) (α-linolenic acid) 0–6 months ND 0.5
7–12 months ND 0.5
1–3 years 0.7
4–8 years 0.9
9–13 years 1.2 (m), 1.0 (f )
14–18 years 1.6 (m), 1.1 (f )
Saturated and trans fatty acids, and cholesterol
0–6 months ND
7–12 months ND
1–3 years ND
4–8 years ND
9–13 years ND
14–18 years ND
Protein (g/day) 0–6 months ND 1.52 (g/kg/day)
7–12 months 11
1–3 years 13
4–8 years 19
9–13 years 34
14–18 years 52 (m), 46 (f )
Biotin (mcg/day) 0–6 months 5
7–12 months 6
1–3 years 8
4–8 years 12
9–13 years 20
14–18 years 25
Choline (mg/day) 0–6 months 125 ND
7–12 months 150 ND
1–3 years 200 1000
4–8 years 250 1000
9–13 years 375 2000
14–18 years 3000
Folate (mcg/day) 0–6 months 150 65 ND
7–12 months 200 80 ND
1–3 years 300 300
4–8 years 400 400
9–13 years 600
14–18 years 800
Niacin (mg/day) 0–6 months 6 2 ND
7–12 months 8 4 ND
1–3 years 12 10
4–8 years 16 (m), 14 (f ) 15
9–13 years 20
14–18 years 30
Pantothenic acid (mg/day) 0–6 months 1.7
7–12 months 1.8
1–3 years 2
4–8 years 3
9–13 years 4
14–18 years 5
Ribofl avin (mg/day) (vitamin B2)
0–6 months 0.5 0.3
7–12 months 0.6 0.4
1–3 years 0.9
4–8 years 1.3 (m), 1.0 (f ) 9–13 years
14–18 years Table 8–2. (Continued)
(continued)
Dietary Reference Intakes
Nutrient Age RDA AI UL
Thiamin (mg/day) (vitamin B1) 0–6 months 0.5 0.2
7–12 months 0.6 0.3
1–3 years 0.9
4–8 years 1.2 (m), 1.0 (f ) 9–13 years
14–18 years Vitamin A (mcg/day)
(Retinol Activity Equivalent)
0–6 months 300 400 600
7–12 months 400 500 600
1–3 years 600 600
4–8 years 900 (m), 700 (f ) 900
9–13 years 1700
14–18 years 2800
Vitamin B6 (mg/day) (pyridoxine) 0–6 months 0.5 0.1 ND
7–12 months 0.6 0.3 ND
1–3 years 1.0 30
4–8 years 1.3 (m), 1.2 (f ) 40
9–13 years 60
14–18 years 80
Vitamin B12 (mcg/day) (cobalamin) 0–6 months 0.9 0.4
7–12 months 1.2 0.5
1–3 years 1.8
4–8 years 2.4
9–13 years 14–18 years
Vitamin C (mg/day) (ascorbic acid) 0–6 months 15 40 ND
7–12 months 25 50 ND
1–3 years 45 400
4–8 years 75 (m), 65 (f ) 650
9–13 years 1200
14–18 years 1800
Vitamin E (mg/day) (α-tocopherol) 0–6 months 6 4 ND
7–12 months 7 5 ND
1–3 years 11 200
4–8 years 15 300
9–13 years 600
14–18 years 800
Vitamin D (mcg/day) (calciferol) (1 mcg calciferol ⫽ 40 IU vitamin D)
0–6 months 5 25
7–12 months 5 25
1–3 years 5 50
4–8 years 5 50
9–13 years 5 50
14–18 years 5 50
Arsenic 0–6 months ND ND
7–12 months ND ND
1–3 years ND ND
4–8 years ND ND
9–13 years ND ND
14–18 years ND ND
Boron (mg/day) 0–6 months ND ND ND
7–12 months ND ND ND
1–3 years ND ND 3
4–8 years ND ND 6
9–13 years ND ND 11
14–18 years ND ND 17
Table 8–2. (Continued)
Dietary Reference Intakes
Nutrient Age RDA AI UL
Calcium (mg/day) 0–6 months 210 ND
7–12 months 270 ND
1–3 years 500 2500
4–8 years 800 2500
9–13 years 1300 2500
14–18 years 1300 2500
Chromium (mcg/day) 0–6 months 0.2
7–12 months 5.5
1–3 years 11
4–8 years 15
9–13 years 25 (m), 21 (f )
14–18 years 35 (m), 24 (f )
Copper (mcg/day) 0–6 months 340 200 ND
7–12 months 440 220 ND
1–3 years 700 1000
4–8 years 890 3000
9–13 years 5000
14–18 years 8000
Fluoride (mg/day) 0–6 months 0.01 0.7
7–12 months 0.5 0.9
1–3 years 0.7 1.3
4–8 years 1 2.2
9–13 years 2 10
14–18 years 2 10
Iodine (mcg/day) 0–6 months 90 110 ND
7–12 months 90 130 ND
1–3 years 120 200
4–8 years 150 300
9–13 years 600
14–18 years 900
Iron (mg/day) 0–6 months 11 0.27 40
7–12 months 7 40
1–3 years 10 40
4–8 years 8 40
9–13 years 11 (m), 15 (f ) 40
14–18 years 45
Magnesium (mg/day) 0–6 months 80 30 ND
7–12 months 130 75 ND
1–3 years 240 65†
4–8 years 410 (m), 360 (f ) 110†
9–13 years 350†
14–18 years 350†
Manganese (mg/day) 0–6 months 0.003 ND
7–12 months 0.6 ND
1–3 years 1.2 2
4–8 years 1.5 3
9–13 years 1.9 (m), 1.6 (f ) 6
14–18 years 2.2 (m), 1.6 (f ) 9
Molybdenum (mcg/day) 0–6 months 17 2 ND
7–12 months 22 3 ND
1–3 years 34 300
4–8 years 43 600
9–13 years 1100
14–18 years 1700
Table 8–2. (Continued)
(continued)
Dietary Reference Intakes
Nutrient Age RDA AI UL
Nickel (mg/day) 0–6 months ND ND ND
7–12 months ND ND ND
1–3 years ND ND 0.2
4–8 years ND 0.3
9–13 years ND 0.6
14–18 years ND 1.0
Phosphorus (mg/day) 0–6 months 460 100 ND
7–12 months 500 275 ND
1–3 years 1250 3000
4–8 years 1250 3000
9–13 years 4000
14–18 years 4000
Selenium (mcg/day) 0–6 months 20 15 45
7–12 months 30 20 60
1–3 years 40 90
4–8 years 55 150
9–13 years 280
14–18 years 400
Silicon 0–6 months ND ND
7–12 months ND ND
1–3 years ND ND
4–8 years ND ND
9–13 years ND ND
14–18 years ND ND
Vanadium (mg/day) 0–6 months ND ND ND
7–12 months ND ND ND
1–3 years ND ND ND
4–8 years ND ND ND
9–13 years ND ND ND
14–18 years ND ND ND
Zinc (mg/day) 0–6 months 3 2 4
7–12 months 3 5
1–3 years 5 7
4–8 years 8 12
9–13 years 11 (m), 9 (f ) 23
14–18 years 34
*(m)⫽ male; (f) ⫽ female.
†Supplemental.
Table 8–2. (Continued)
approximately the average, rather than two standard deviations above the average. The DRIs take into con- sideration both gender and age in establishing require- ments. This discussion will adhere to the age groups used in the DRIs. They are: 0–6 months, 7–12 months, 1–3 years, 4–8 years, 9–13 years, and 14–18 years.
Table 8–2 lists the DRIs for a number of nutrients.
Table 8–3 shows how to calculate energy requirements and Table 8–4 lists approximate energy requirements from infancy to adolescence.