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Dietary Reference Intakes for Calcium,
Phosphorus, Magnesium, Vitamin D,
and Fluoride1
Two university researchers presented information about Dietary Ref-erence Intake (DRI) research recommendations contained in the Calcium and Related Nutrients Report (IOM, 1997). Bess Dawson-Hughes of Tufts University, who served on the panel for the report, highlighted a number of research recommendations that were considered to be of ma-jor importance for each of the five nutrients covered in the report and then made some comments about progress in those areas. Bruce W. Hollis of Medical University of South Carolina focused on the dietary requirement for vitamin D, which is his area of research.
DRI REPORT ON CALCIUM AND RELATED NUTRIENTS
Presenter: Bess Dawson-Hughes
Calcium
Major research recommendations for calcium included defining (1) the impact of calcium intake on mineral metabolism and peak bone mass;
(2) genetic and calcium intake interactions; (3) the impact of calcium intake by adults on skeletal end points and on nonskeletal end points 1This chapter is an edited transcript of remarks and slides by Drs. Bess Dawson-Hughes and Bruce Hollis at the workshop. Comments made by Dr. Dawson-Hughes rep-resent a composite of input from many of the panel members including Stephanie Atkin-son, Steve Abrams, Bob Heany, Robert Rude, Connie Weaver, and Gary Whitford, and from James Penland (regarding magnesium).
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20 DIETARY REFERENCE INTAKES such as blood pressure, cancer risk, and diabetes; and (4) the impact of calcium intake on the risk of developing a first or recurrent kidney stone.
The most notable progress is a much better understanding of the link between calcium intake and absorption, particularly in adolescents. In addition, data now relate some of the vitamin D polymorphisms to min-eral metabolism in children. Information from Goulding and others (1998) indicates that milk intake in childhood influences fracture rates both in childhood and later in life in women.
The longest of several recent calcium intervention trials is a 7-year intervention study conducted by Matkovic et al. (2005). That study found that the bone mineral density of girls who were taller at the end of the 7-year interval benefited from supplementation. The results raise the ques-tion as to whether calcium intake should be set on the basis of body size, at least in children and adolescents.
Racial differences in bone turnover and calcium metabolism have been described. Over the last nine years, numerous randomized con-trolled trials of adults have been published. The studies that had a pla-cebo group with a low calcium intake and a reasonable level of compliance generally have shown beneficial effects of calcium supple-mentation on bone.
The Dietary Approaches to Stop Hypertension (DASH) Study has looked at dairy food intakes to reduce blood pressure. Several studies identify a small (3% to 5%) inverse effect of calcium on weight. That is controversial, but there seems to be a low-level association.
Data on the effect of high calcium intake on the occurrence of first kidney stone now are available from approximately 36,000 women in the Women’s Health Initiative. Reportedly, a comprehensive analysis of the stone risk is underway. The report by Borghi et al. (2002) provides data on associations of calcium intake and recurring stones.
One recent 5-year calcium intervention trial (Prince et al., 2006) was conducted in western Australia. The trial included approximately 1,500 women with a mean age of 75 years. Usual calcium intakes averaged approximately 900 milligrams per day. This was a placebo-controlled trial in which the supplement provided 1,000 mg of calcium in the form of calcium carbonate. Table 3-1 shows that only about 57 percent of the subjects in the cohort had an adherence rate of 80 percent or higher. This actually is a fairly good degree of adherence for a very long intervention study. The subset of adherents had a statistically significant reduction in all fracture risk. Those in the intent-to-treat group had a similar trend, but it was not significant.
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CALCIUM, PHOSPHORUS, MAGNESIUM, VITAMIN D, AND FLUORIDE 21
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TABLE 3-1 Effect of 1,200 mg of Calcium Supplement Versus Placebo on Fracture Risk
Percent of Subjects Hazard Ratio [95% CI] All subjects 100% 0.87 [0.67–1.12] Adherent subjects b 57% 0.66 [0.45–0.97] a
b Subjects maintaining an adherence rate of at least 80 percent.
SOURCE: Prince et al., 2006.
Vitamin D
Among the primary research recommendations for vitamin D are to
(1) define optimal serum 25-hydroxyvitamin D [25-(OH)D] concentra-tion according to age group, race, and latitude; and (2) define relation-ships between intake of vitamin D and serum 25-(OH)D.
The process of defining optimal vitamin D intake has been unfolding along the following lines over the last nine years. Three steps in the process are identifying the biological action affected by vitamin D, de-termining the amount of 25-(OH)D needed to optimize function for that biological action, and then defining the relationship between intake and serum 25-(OH)D.
Previously, parathyroid hormone (PTH) suppression was the primary gauge of optimum vitamin D status. Then, considerable development occurred in the biological action arena, particularly regarding muscu-loskeletal end points. Bone density, muscle performance, falls, and frac-tures now are key vitamin D musculoskeletal end points. A burgeoning area involves associations of vitamin D intake and 25-(OH)D with a wide variety of other very important end points, including the risk of de-veloping diabetes, cancer, infection, periodontal disease, and osteoarthri-tis. These health problems involve a large proportion of the population.
A cross-sectional study out of Iceland, in over 900 individuals, ex-amined the relative contributions of calcium and vitamin D to PTH sup-pression. Figure 3-1 shows that subjects were sorted by three categories of calcium intake, shown in the three types of bars and by categories of 25-(OH)D concentrations, shown on the X axis. In persons with very low 25-(OH)D concentrations, below 25 nmol/L, PTH was suppressed by increasing calcium intake. However, as the vitamin D concentration in-creases above 25 nmol/L, calcium plays a less obvious role in suppress-
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ing PTH. In Iceland, two-thirds of the people were at 25 nmol/L or more of 25-(OH)D, and in populations residing closer to the equator, one would expect to find a greater proportion with vitamin D concentrations greater than 25 nmol/L.
Table 3-2 lists vitamin D placebo-controlled intervention trials rele-vant to estimating the optimal 25-(OH)D concentration. The table in-cludes the author, the dosage of vitamin D administered compared with placebo (some with calcium, some not), the 25-(OH)D concentration achieved on supplementation, and the changes in parathyroid hormone. It shows that four of the eight studies demonstrated a positive effect on nonvertebral fracture risk reduction. Based in part on these study results, many are estimating that a 25-(OH)D concentration of 75 nmol/L or higher will reduce the risk of fracture more than would lower concentra-tions of 25-(OH)D.
Calcium intake (mg/d)
< 800
< 25 25–45 Serum 25-Hydroxyvitamin D (nmol/L) S e r u m P a r a t h y r o i d H o r m o n e (p g /m L )60
50403020
> 45
FIGURE 3-1 Serum parathyroid hormone concentration by serum 25-hydroxyvitamin D level and by level of calcium intake.
SOURCE: Steingrimsdottir et al. 2005. JAMA . 294: 2336-41. Copyright 2005, American Medical Association . All rights reserved.
CALCIUM, PHOSPHORUS, MAGNESIUM, VITAMIN D, AND FLUORIDE 23
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TABLE 3-2 Serum 25-Hydroxyvitamin D, Parathyroid Hormone, and Nonvertebral Fracture Responses to Supplementation with Vitamin D 3 Author, Year
Dose (IU/d) 25-(OH)D (nmol/L) ?PTH (%) Effect on Nonvertebral Fracture Chapuy et al., 1992
800 100 -33 + Dawson-Hughes et al., 1997
700 112 -28 + Trivedi et al., 2003
820 74 ? + Grant et al., 2005
800 63* 0 NS Jackson et al., 2006
400 59* ? NS Lips et al., 1996
400 54 -6 NS Meyer et al., 2002 400 64 ? NS NOTE: ?PTH = Change in parathyroid hormone concentration; NS = no statistically significant effect. *Estimates in subsets of subjects.
It appears more useful to consider the 25-(OH)D concentration than the supplement dose. Take the case, for example, of the Randomized Evaluation of Calcium or Vitamin D (RECORD) Trial (Grant et al., 2005). The investigators gave the same dose of vitamin D as was given in many of the positive trials. Their compliance, however, was low: only half the subjects were taking any supplements at all at the 2-year mark into the 5-year trial. Consequently, the dose consumed could not have been as high as the amount being delivered.
Progress has been made regarding the safety of vitamin D. In a study involving daily dosing with either 1,000 or 4,000 IU of vitamin D per day over a 5-month period, no toxicity was invoked. In panel B (the 4,000 IU dose of vitamin D 3) in Figure 3-2, the mean serum 25-(OH)D concentration achieved was 100 nmol/L. Nearly all subjects were in the desired range of 75 to 80 nmol/L or higher. Although one subject’s 25-(OH)D value rose to 138 nmol/L, that is a typical level for a person who works outdoors in the sun in the summertime. An average lifeguard will have a 25-(OH)D concentration of approximately 160 nmol/L. There is no sense of concern about the serum vitamin D concentrations shown in Figure 3-2.
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S e r u m 25(O H )D (n m o I /L )
S e r u m 25(O H )D (n m o I /L )
FIGURE 3-2 Serum 25-hydroxyvitamin D responses to two levels of vita-min D 3 supplementation over 6 months.
NOTE: A = 1000 IU/d of vitamin D 3; B = 4000 IU/d of vitamin D 3.
SOURCE: Veith et al. (2001). Reproduced with permission from The American Journal of Clinical Nutrition .
Data are just beginning to appear concerning vitamin D needs of children. However, much information still is needed, particularly for children in the age range of 6 months to 8 years. A very recent interven-tion study with 200 or 400 IU of vitamin D looked at the change in bone mineral content in young adolescent girls over a 1-year interval. Results showed step increases in the change in bone mineral content with more vitamin D supplementation.
For adults, more data are needed to refine estimates that 75 to 80 nmol/L of serum 25-(OH)D are needed for the musculoskeletal end points. There also is a great need to obtain threshold estimates for the chronic disease end points mentioned earlier. An enormous amount of work is being conducting in this area now.
Additional needs include standardization of 25-(OH)D assays and better quantitation of the vitamin D content of foods. For example, the vitamin D values for salmon (one of the main food sources of this vita-min) are based on wild salmon. Does farm salmon, which currently is widely consumed, have the same vitamin D content?
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Phosphorus
For phosphorus, there were two key research recommendations: (1) for ages 1 to 18 years, to define the intake needed to optimize bone ac-cretion; and (2) for children and adults, to define the relationship be-tween phosphorus intake and the concentration of phosphorus in the blood.
Relatively little progress appears to have occurred in this area. Cur-rent identified research needs concern the potential problem of low phos-phorus intake, especially by older individuals in the United States; the extent to which the increasing use of calcium supplements may decrease the bioavailability of phosphorus; and a potential increased need for phosphorus related to the introduction of anabolic agents for the treat-ment of osteoporosis.
Magnesium
The key research recommendations for magnesium were to (1) iden-tify the magnesium intake needed for maximum accretion of bone in children and for preservation of bone in adults; (2) identify associations between magnesium intake and the development of other conditions such as hypertension, cardiovascular disease, and diabetes; and (3) identify and validate an accurate indicator of magnesium status.
Some interesting animal and epidemiological studies have been pub-lished recently, as mentioned briefly here. Rude and coworkers (2004, 2005, 2006) conducted several elegant magnesium depletion studies in rats. Table 3-3 shows that at half of the magnesium requirement, trabecu-lar bone volume was decreased, and osteoclast number was higher. With further and further magnesium depletion, these effects became more ex-aggerated in the rats and, in addition, tumor necrosis factor-alpha con-centrations rose. Unfortunately, parallel data in humans are unavailable.
TABLE 3-3 Magnesium Depletion and the Skeleton in Rats
Study Diet, % Nutrient Requirement Outcome
Rude et al., 2004 50 ↓ Trabecular volume, ↑ osteoclast number
Rude et al., 2005 25 also ↑ TNF-alpha Rude et al., 2006 10 also ↑ TNF-alpha NOTE: TNF-alpha = tumor necrosis factor alpha
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Two large epidemiologic studies involving large numbers of subjects with long follow-up periods are of special interest. In these studies, the subjects in the highest versus lowest quintile of magnesium intake had a decreased risk of developing both type II diabetes (Lopez-Ridaura et al., 2004) and stroke (Ascherio et al., 1998). Although these studies can help develop hypotheses that may be promising, the approach does not really isolate a nutrient—especially since the magnesium from food tends to be accompanied by other important nutrients.
Little has changed with regard to the indicators of magnesium status, but a report by Barbagallo and colleagues (2000) merits consideration. This study makes use of the facts that 99 percent of magnesium in the body is intracellular and that, of this, approximately 10 to 15 percent is in the ionized metabolically active form. These investigators found no dif-ferences in the free intracellular magnesium concentrations of normal subjects compared to hypertensive individuals or compared to persons with diabetes.
Fluoride
Key research recommendations for fluoride include (1) conducting epidemiologic research on habitual exposure to fluoride, particularly fo-cusing on the prevention of dental caries, quality of bone, and the risk of developing fluorosis; and (2) identifying the factors that influence fluo-ride absorption and retention.
Two very comprehensive and important reports on fluoride were published over the last seven years—an epidemiologic study by Sowers et al. (2005) and another from the National Health and Nutrition Exami-nation Survey (NHANES) by Beltran-Aguilar et al. (2005). The study by Sowers and colleagues had 4 years of follow-up and looked at fractures and changes in bone density in 1,300 women in three different communi-ties in Iowa. The control community had a fluoride content of 1 ppm in the water supply (within the recommended level), and mean calcium in-take was 754 mg/day. For comparison, one of the communities had the same fluoride content in the water but a high mean calcium intake (1,001 mg/day). The other test community had a high fluoride content (4 ppm) of the water, but calcium intake was comparable to that of the control community.
The bottom line is that the fracture rates were similar in the three communities. Bone densities were similar, with the exception of a minor PREPUBLICATION COPY: UNCORRECTED PROOFS
CALCIUM, PHOSPHORUS, MAGNESIUM, VITAMIN D, AND FLUORIDE 27 increase in the forearm in the high fluoride community. These results do not raise much concern about fluoride in these communities.
Using NHANES data, Beltran-Aguilar et al. (2005) compared certain dental outcomes from the period of 1988–1994 with the same outcomes from 1999–2002. The investigators found that caries in permanent teeth in the United States have declined, as has tooth loss in older adults. The prevalence of enamel fluorosis has increased, however, starting in 1980. Racial and ethnic disparities persist in the prevalence of caries and enamel fluorosis.
THE DIETARY REQUIREMENT FOR VITAMIN D: LOOKING
BEYOND BONE
Presenter: Bruce Hollis
This presentation focused on vitamin D. Dr. Hollis took the position that vitamin D2 (the form of vitamin D obtained by the irradiation of er-gocalciferol from plants) should be removed from use in food supple-ments and that vitamin D3 (the form of the vitamin that is produced by the action of ultraviolet light on vitamin D precursors in the skin) should be used instead. The biggest reason given for this position is that vitamin D2 is less biologically active than vitamin D3 (Armas et al., 2004). Giv-ing vitamin D2 elicits more variable responses in 25-(OH)D values than does giving vitamin D3.
Vitamin D3 is metabolized fairly rapidly to 25-(OH)D, which is the major circulating form of vitamin D and is a biomarker for vitamin D status. One can influence the concentration of 25-(OH)D through diet or sun exposure, but one can have little influence on the amount of circulat-ing 1,25-(OH)2D—the active form of the vitamin. Vitamin D metabolism differs depending on the amount of vitamin D3 supplied to the body. When vitamin D supplies are inadequate, the flow of 25(OH)D through other potential pathways, including its utilization by peripheral tissues for paracrine regulation, is compromised. Dr. Hollis indicated that a chronic depleted status may be common today and that a depleted vita-min D status poses risks for within-tissue processing.
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Research Questions on Vitamin D Requirements Research on vitamin D requirements needs to consider the cutaneous generation of vitamin D and differences in vitamin D3 generation that relate to skin color, latitude, the use of sun screen, and the amount of skin actually exposed to the sun. In view of the relative lack of vitamin D3 in the food supply and public health recommendations to use sun screen to reduce the risk of skin cancer, what amount of oral vitamin D supplementation should be provided? Heaney et al. (2003) examined the response of 25-(OH)D as a function of oral vitamin D3 intake over a 5-month period. Circulating 25-(OH)D values at the highest intakes (5,000 to 10,000 IU/day) were comparable to those resulting from extensive solar exposure, and those at the lowest intakes (400 to 1,000 IU/day) tended to decrease over time.
According to Dr. Hollis, the 400 IU (10 μg) dose of vitamin D sup-plied to subjects in the Women's Health Initiative studies was too small to increase the 25-(OH)D values at all. He based his position on the 2003 Heaney et al. study, including a regression of the equilibrium increment in serum 25-(OH)D concentration on the labeled dose for the mean in-take by each treatment group.
Another important question involves the identification of optimal circulating concentrations of 25-(OH)D. Different types of evidence sug-gest that concentrations previously identified as normal are too low. In particular, Dr. Hollis noted problems with the interpretation of the study by Haddad and Chyu (1971) that identified a low 25-(OH)D level as normal. A biomarker would be especially useful if it would respond to both increases and decreases in the 25-(OH)D concentration.
Dr. Hollis indicated that effects of vitamin D on PTH are well known, as are vitamin D interactions in bone. He considers insulin sensi-tivity, beta cell function, immune function, and circulating cytokines (both proinflammatory and anti-inflammatory), and cardiac health to be promising research areas.
There are several examples of relationships of vitamin D with infec-tion. A recent study by Liu and colleagues (2006) provides an explana-tion for findings by Finsen (Rochietta, 1960) that ultraviolet light benefits patients with lupus vulgaris and for the demonstrated beneficial effects of ultraviolet light exposure on tuberculosis patients in sanitoria. In particular, the study found that human toll-like receptor triggers a vi-tamin D receptor-dependent antimicrobial response. This response in-PREPUBLICATION COPY: UNCORRECTED PROOFS
CALCIUM, PHOSPHORUS, MAGNESIUM, VITAMIN D, AND FLUORIDE 29 volves the innate immune system, which provides the first response to pathogens when they invade the body.
In Caucasians and African Americans, Liu and coworkers (2006) showed that nutritional vitamin D status controlled cathelicidin, an an-timicrobial peptide made by monocytes and macrophages. At low con-centrations (20 or 30 nmol/L) of serum 25-(OH)D, subjects could not mount a response to kill the internalized tuberculosis in the macrophages. After supplementation with vitamin D in amounts sufficient to achieve serum 25-(OH)D concentrations of 80 nmol/L, the subjects could mount this attack, produce cathelicidin, and attack the tuberculosis.
A brief study conducted in India (Rehman, 1994) shows that vitamin D supplements of 60,000 IU/week for 6 weeks could help children with elevated alkaline phosphatase concentrations to overcome respiratory infections.
A study by Giovannucci and colleagues (2006) estimates the effects of a 25-nmol/L increase in serum 25-(OH)D in a population on the odds ratios of developing various forms of cancer. For 11 of the 14 forms of cancer, the odds ratios of developing those cancers are less than one. Ad-ditional work is in progress.
A small pilot vitamin D supplementation study (Wagner et al., 2006) looked at periodic changes in maternal and infant blood concentrations of 25-(OH)D and of vitamin D activity in mother’s milk. The study found that the higher level of maternal vitamin D3 supplementation (6,400 IU compared with 400 IU) resulted in substantial increases in vitamin D3 and 25-(OH)D in the mother and in milk vitamin D activity. The serum 25-(OH)D concentration in the infants of the highly supplemented women was comparable to that of infants who were supplemented di-rectly.
Dr. Hollis challenged the current Adequate Intake (AI) of 10 μg of vitamin D/day for adults and probably for adolescents as not supportive of health. He stated that it is almost certain that chronic deficiency of vitamin D puts populations at risk for debilitating chronic diseases. Moreover, he posited that a serum concentration of 80 nmol/L of 25-(OH)D, which has been proposed to protect the skeleton, is too low to reduce the risk of muscular sclerosis or cancer or to promote immune function.
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Tolerable Upper Intake Level for Vitamin D Dr. Hollis challenged the Tolerable Upper Intake Level (UL) that the Institute of Medicine set for vitamin D. In studies by Hollis and Wagner (2004), Wagner et al. (2006), and Heaney et al. (2003) involving 10,000 IU/day of vitamin D (or more), no instances of hypercalciuria or hyper-calcemia occurred. Furthermore, Dr. Hollis indicated that the low UL is an impediment to human health because it sets too low a limit on what the vitamin manufacturers can add to their vitamin supplements.
DISCUSSION
Questions and comments by Drs. Dennis Bier, Irwin Rosenberg, Larry Appel, Paul Pencharz, and Robert Russell are summarized below, along with responses from the presenters.
Optimal Parathyroid Hormone level
Dr. Bier asked how one defines the optimal PTH level in the context of adequacy. Drs. Hollis and Dawson-Hughes responded that many sound studies with reliable PTH assays have looked at this relationship. They all indicate that one can suppress PTH serially only until the 25-(OH)D concentration reaches approximately 80 nmol/L. Lower rates of bone loss provide the basis for the suppression. Neither calcium nor vi-tamin D (nor both) can suppress PTH more than a maximum of 80 to 90 percent. In such studies, the calcium range is defined in the usual way, with a group of healthy individuals.
Circular Argument
Dr. Bier expressed concern about issues related to PTH suppression and about a circular argument relating to the reference range for calcium. In particular, the reference range for calcium was said to be defined by values obtained from a group of “healthy individuals,” but presentations pointed out the high prevalence of inadequate vitamin D in the popula-tion, which presumably is not healthy. Dr. Hollis responded that some recent studies address the points of having an adequate calcium index PREPUBLICATION COPY: UNCORRECTED PROOFS
CALCIUM, PHOSPHORUS, MAGNESIUM, VITAMIN D, AND FLUORIDE 31 and setting the PTH reference ranges in relation to adequate vitamin D status.
Measures of Early Adverse Effects
Dr. Rosenberg asked what are potential measures of early adverse effects. Dr. Dawson-Hughes responded that probably the easiest and least expensive measure to obtain would be a random spot-urine calcium, which correlates very highly with the 24-hour urine calcium-to-creatinine ratio. That correlation is so strong that one would not need to conduct a 24-hour urine collection to assess safety. Basically, the random spot-urine calcium content would increase before the renal threshold was ex-ceeded and before an increase in the blood calcium concentration oc-curred. Thus, the random spot-urine calcium would be an early point for detection, and it would be easier to interpret than a PTH value. Such a measurement would not be used to set a requirement but to monitor for safety. Dr. Hollis agreed that the random spot-urine calcium could be measured easily in a research setting or a clinical setting. He added that, because PTH is potentially cardiotoxic, it probably is in the interest of cardiovascular health to have lower PTH concentration as well. Dr. Daw-son-Hughes stated that there is no evidence of any extension of the curve of the inverse relationship between insufficient levels of either calcium or vitamin D intake and PTH concentration.
Vitamin D and Chronic Illness
Dr. Hollis suggested that lack of vitamin D might be related to the high prevalence of lupus, multiple sclerosis, and diabetes among a popu-lation of African Americans called the Gullah in South Carolina. He re-ported that their vitamin D concentrations were the lowest he had ever seen.
Clarification of Units
Dr. Bier asked about the dramatic increase in maternal vitamin D in-take that had a relatively small effect on circulating 25-(OH)D concentra-tions for the mother and the baby—the circulating levels for the mother PREPUBLICATION COPY: UNCORRECTED PROOFS
32 DIETARY REFERENCE INTAKES and the infant were still below 80. Dr. Hollis clarified that the units are nanograms. To convert nanograms to nanomoles, one multiplies that number times 2.5.
Maternal-Infant Findings
Dr. Pencharz referred to a Muslim woman who bore a baby with neonatal rickets. These investigators in Saudi Arabia were able to treat the neonatal rickets by having the mother exposed to sunlight. That proved in a biological way what Dr. Hollis has shown biochemically. It appears that the evidence now supports recommendations to supplement the mother. Dr. Hollis responded that blinded maternal studies are un-derway but the increased blood concentrations of 25-(OH)D clearly indi-cate the individuals who are receiving the vitamin D. Data still are needed.
A model of the transfer of vitamin D during lactation is evolving. In response to questions from Dr. Allen, Dr. Hollis indicated that about 0.5 percent of the circulating 25-(OH)D passes into breast milk but that 30 to 80 of the parent compound (vitamin D3) passes into the milk.
Persistence of Circulating 25-(OH)D
Dr. Russell asked how long very high blood concentrations of 25-(OH)D persist after extensive sun exposure, as in a life guard working outside. Dr. Dawson-Hughes was unaware of such data but referred to data from healthy older subjects in Boston. In the summer, their concen-tration of 25-(OH)D is approximately 80, and it decreases to about 60 in the winter. Dr. Hollis stated that the half life of 25-(OH)D is approxi-mately 3 weeks.
Vitamin D2 Versus D3
Dr. Whiting asked Dr. Dawson-Hughes to elaborate on the relative value of vitamin D2 and D3. Dr. Dawson-Hughes responded that, from the current available evidence, D3 is preferred. Although the evidence base is not extensive, it is consistent in suggesting that, for a given dose of D2 or D3, over at least a 2-week period, a considerably larger increment in the PREPUBLICATION COPY: UNCORRECTED PROOFS
CALCIUM, PHOSPHORUS, MAGNESIUM, VITAMIN D, AND FLUORIDE 33 total 25-(OH)D concentration occurs with repeated dosing with vitamin D3.
The study by Armas and colleagues (2004), which used a single dose of 50,000 units of vitamin D2 or D3, found similar increments in 25-(OH)D over the first 3 days; but subsequently the total 25-(OH)D con-centration decreased in the D2-treated subjects. In fact, it was lower than baseline at the end of 30 days. In contrast, the concentration in the D3-treated subjects remained well above the baseline level at 30 days. Thus, the staying power of the single dose of vitamin D3 is greater, and the in-crement over 2 weeks is greater. Vitamin D2 can be effective, but it takes a much larger dose on a frequently repeated dosing regimen.
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膳食营养素摄入量计算和评价举例和习题
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膳食营养素摄入量计算和评价举例和习题 一、举例：某65岁老年女性的一日食谱如下: 早餐 鲜牛奶一杯(２００ｇ），馒头一个(小麦标准粉１00ｇ) 中餐 米饭(粳米，标一100g ）,猪肉炒芹菜(猪腿肉100g,芹菜２50g,酱油10g ，大豆油6g ， 盐2ｇ） 晚餐 米饭（粳米，标一100g)，生菜豆腐汤(生菜100ｇ，豆腐１00g,大豆油6g,盐２g)， 清蒸鲈鱼(200g) 所食用食物的成分表(１00g 可食部含量） 1. 根据上述食谱,计算该对象一日能量及营养素摄入量 : 食物 名称 食部（%） 能量(kc ａｌ) 蛋白质 (g ） 脂肪(g) 碳水化物(ｇ） 维生素Ａ (μgRE) 硫胺素(mg) 维生素C (mg) 钙(mg) 铁m ｇ 牛奶 100 5４ ３．０ 3．2 3.４ 2４ ０.03 1 10４ 0.3 面粉 １00 344 11.2 １.5 73.６ ０ ０ ０ 14 ０．6 粳米 100 346 7.4 0.8 ７7.9 0 0 0 ２９ 1.5 猪 肉 （腿) 10０ 190 17.9 12.8 0.８ 3 ０.5３ 0 6 0．9 芹菜 ６7 20 １．２ 0.2 ３．３ ５7 ０.02 8 80 1.2 酱油 100 66 8.3 0.6 ６.9 0 0.０３ ０ 27 7.0 大豆油 １０0 900 0.0 ９9.9 ０.1 0 0 ０ 1 ０．3 盐 １ 1.0 生菜 ９４ １３ 1.３ 0.3 1.3 2９8 0.０3 13 ３４ 0．9 豆腐 100 81 8．1 3．7 3.8 ０ 0.04 0 164 1.9 鲈鱼 58 100 18.6 ３.4 19 0.0３ 1３８ 2.0 食物 名称 摄入量 能量(kcal) 蛋白质 (g ） 脂肪(g) 碳水化物(ｇ) 维生素A (μｇＲＥ) 硫胺素(ｍg) 维生素Ｃ (mg ） 钙(mg ） 铁mg 牛奶 200 5４×2＝１ ０8 3.0×2＝6 3.２×2=6.4 3.4×2＝6.8 24×2=48 ０.03×2=0．0６ 1×2=2 104×２=20８ 0.3×2＝0. ６ 面粉 １00 344 11．2 1.5 73.6 0 ０ 0 14 0.6 粳米 100 346 7.4 0.8 77.9 0 0 ０ 29 1.5 猪肉（腿) 100 １90 17．9 12.８ 0．8 3 0.53 ０ 6 0.9 芹菜 25０ 20×2.５× ０.67=3３．5 1．2×2.5×0.６7=2.０1 0.2×２.5×０.67=0.3４ 3.３×２.5×0.67=5.53 ５7×2.5×０.67=95.４８ 0．０2×2.５×0.67＝0.0３ 8×２.5×０.6７=13.４ 80×２.5×０.67=13 4 1．２×2.5×０．6７=2.01 酱油 10 66×０.1=6.6 8．3×０．1=0.8 ３ 0.6×0.１＝0.06 6.９×０．1＝ ０ 0.０3×0.1=0. 27×0.１=2.7 7.0×0.1=0. ７
营养师培训实习指导——膳食调查与营养评价 班级________ 学号_________ 姓名_________ 性别____ 一、目的要求 1、了解膳食调查的意义，进一步掌握膳食调查是营养调查的一部分。 2、初步掌握膳食调查的方法和食物成分表的应用，了解每人每日各种主副食的摄入量。 3、利用食物成分表计算每人每日从膳食中所摄取的热能和各种营养素是否达到供给标准的要求，并评价膳食构成是否合理，提出改进方法。 二、调查时间 调查时间为5-7天，从本周（月日）午餐开始至下周（月日）早餐结束。 三、调查内容和方法 本次调查以学员自身膳食为例，采用自己记录每日每餐膳食情况，计算每日膳食。 1、资料的收集 记录调查时间内每日每餐所食食物的种类和数量。 2、计算每人每日各种营养素摄入量 应用“食物成分表”计算各种食物的各种营养素含量，然后计算每人每日各种营养素摄入量。 3、评价每人每日各种营养素摄入量情况 参照2000年中国营养学会“中国居民膳食中营养素参考摄入量Chinese DRI S”标准进行膳食评价。查出与自己年龄、劳动强度相符的供给量，计算摄入量占供给量的百分比，评价摄入量充足与否。 4、计算热量、蛋白质及铁的来源分布 将各种食物分为动物类、豆类、一般植物类（不含豆类）三类。分别计算来源于动物类、豆类、一般植物类热量、蛋白质和铁的摄入量并计算其占总量的百分比。由此评价热量、蛋白质和铁的不同来源优劣。 5、计算一日三餐热量分配百分比 将早、中、晚餐食物分别列出，计算其热量，并计算其占总热量的百分比。 6、计算膳食中热能来源分配 计算食物中蛋白质、脂肪、糖类的摄入量并换算为热量，求出蛋白质、脂肪、糖类占总热量的百分比。 7、膳食构成： 膳食构成与平衡膳食宝塔建议食物参考摄入量对比。 四、膳食评价与膳食改进 1、与推荐供给量比较，分析各种营养素摄入量是否充足，有无摄入不足或过剩现象，应如何改进，提出具体措施。
膳食营养素摄入量计算和评价举例和习题 一、举例：某65岁老年女性的一日食谱如下： 早餐鲜牛奶一杯（200g），馒头一个（小麦标准粉100g） 中餐米饭（粳米，标一100g），猪肉炒芹菜（猪腿肉100g，芹菜250g，酱油10g，大豆油6g，盐2g） 晚餐米饭（粳米，标一100g），生菜豆腐汤（生菜100g，豆腐100g，大豆油6g，盐2g），清蒸鲈鱼（200g） 所食用食物的成分表（100g可食部含量）
蛋白质的摄入量偏高，能量、钙、铁的摄入量基本满足需要，维生素A、B1和C缺乏，尤以维生素C的缺乏最为明显。 3. 评价三大营养素的供能比例 4. 评价三餐能量分配比 基本合理，晚餐能量摄入量略高，早餐和午餐略低。 5. 评价优质蛋白质所占比例 优质蛋白质所占比例=（动物蛋白+豆类蛋白）/总蛋白质=（6+17.9+8.1+21.6）/83.7×100%=64.0%，大于30%，故优质蛋白质摄入量充足。 6. 根据上述评价结果提出膳食建议。 二、习题
（一）某男大学生的一日食谱如下: 要？表（一）一日中各种食物中的各类营养素摄入计算 表（二）一日营养素摄入量与需要量比较表
表（三）一日所得三大营养素占热能百分比 占比例等方面进行评价及提出膳食改进建议。
（二）成年女性，40岁，从事轻体力劳动，通过膳食调查了解到其一日摄入的食物如下：大米200g、面粉100g、青菜200g、冬瓜100g、鸡蛋100g、带鱼100g、大豆油50g、牛奶200g、苹果200g，（以上重量均为可食部的重量）。 所食用食物的成分表（100g可食部含量） 1、膳食的热能和各种营养素摄取量 3、膳食蛋白质来源 5.根据上述结果进行评价并提出膳食建议
营 养 学 报 《中国居民膳食营养素参考摄入量》2013修订版简介 程义勇 （中国营养学会第七届理事会 理事长；《中国居民DRIs》修订专家委员会 主任委员） 近十几年来，国内外营养科学得到很大发展，在理论和实践的研究领域都取得了一些新的研究成果。 有关国际组织和许多国家的营养学术团体先后在制定和修订“膳食营养素供给量（RDA）”的基础上，制定和发布了《膳食营养素参考摄入量（DRIs）》，为指导居民合理摄入营养素，预防营养缺乏和过量提供了一个重要的参考文件。中国营养学会于2000年制订了《中国居民DRI》，并于2010年将修订工作列为第七届理事会重点任务。为此成立了专家委员会、顾问组和秘书组，讨论确定了修订的原则和方法，组织了80余位营养学专家参与修订。为了保证修订稿的科学水平和学术质量，在筹备阶段确定了“科学性、先进性、全面性”的基本原则；在工作期间召开了多次学术会议和工作会议，交流国内外DRIs 进展及修订经验；在审定阶段采取多种方式对文稿进行多次审核和修改，重要数据都通过集体论证后确认。历时三年有余，经文献检索、科学论证、编写、审校、复核等工作于2013年圆满完成。 《中国居民DRIs》2013修订版的内容分为三篇：概论、能量和营养素、水和其他膳食成分。第一篇说明DRIs 的概念、修订原则、方法及其应用，并简述国内外DRIs 的历史与发展；第二篇分别介绍能量、宏量营养素、维生素和矿物元素的DRIs；第三篇对水和某些膳食成分的生物学作用进行综述。 本次修订的特点主要体现在下述几方面：（一）更多应用循证营养学的研究资料。（二）纳入近十年来营养学研究新成果，增加了10种营养素的EAR/RNI 数值，并尽可能采用了以中国居民为对象的研究资料。（三）基于非传染性慢性病（NCD）一级预防的研究资料，提出了宏量营养素的可接受范围（AMDR），以及一些微量营养素的建议摄入量（PI-NCD）。（四）增加“某些膳食成分”的结构、性质、生物学作用等内容，对科学依据充分的，提出了可耐受最高摄入量（UL）或/和特定建议值（SPL）。（五）说明DRIs 应用程序和方法，为其推广应用提供参考。 DRIs 的基本概念是为了保证人体合理摄入营养素而设定的每日平均膳食营养素摄入量的一组参考值。随着营养学研究的发展，DRIs 内容逐渐增加。2000年第一版包括四个参数：平均需要量、推荐摄入量、适宜摄入量、可耐受最高摄入量。2013年修订版增加与NCD 有关的三个参数：宏量营养素可接受范围、预防非传染性慢性病的建议摄入量和某些膳食成分的特定建议值。 （一）平均需要量（estimated average requirement，EAR） EAR 是指某一特定性别、年龄及生理状况群体中个体对某营养素需要量的平均值。按照EAR 水平摄入营养素，根据某些指标判断可以满足某一特定性别、年龄及生理状况群体中50%个体需要量的水平，但不能满足另外50%个体对该营养素的需要。EAR 是制订RNI 的基础，由于某些营养素的研究尚缺乏足够的人体需要量资料，因此并非所有营养素都能制定出其EAR。 （二）推荐摄入量（recommended nutrient intake，RNI） RNI 是指可以满足某一特定性别、年龄及生理状况群体中绝大多数个体（97%～98%）需要量的某种营养素摄入水平。长期摄入RNI 水平可以满足机体对该营养素的需要，维持组织中有适当的储备以保障机体健康。RNI 相当于传统意义上的RDA。RNI 的主要用途是作为个体每日摄入该营养素的目标值。 RNI 是根据某一特定人群中体重在正常范围内的个体需要量而设定的。对个别身高、体重超过此参考范围较多的个体，可能需要按每公斤体重的需要量调整其RNI。 能量需要量（estimated energy requirement，EER）是指能长期保持良好的健康状态、维持良好的体型、机体构成以及理想活动水平的个体或群体，达到能量平衡时所需要的膳食能量摄入量（WHO，1985）。 群体的能量推荐摄入量直接等同于该群体的能量EAR，而不是像蛋白质等其他营养素那样等于EAR DOI:10.13325/https://www.doczj.com/doc/ec11870190.html,ki.acta.nutr.sin.2014.04.002
营养调查及膳食计算 营养调查(Nutritional Survey) 定义: 运用各种手段准确了解某一人群（以至个体）各种营养指标的水平，用来判定其当前营养状况。 目的: 1.了解居民膳食摄入与DRIs之间的对比 2.了解与营养状况有密切关系的居民体质和健康状况（肥胖、高血压、高血脂、贫血 等人群） 3. 综合性或专题性的科学研究 4.为国家制定政策和社会发展规划提供科学依据 营养调查的组织和设计 1. 调查对象的抽样:多阶段分层整群随机抽样 2. 调查地区分类 3. 地区内人群职业 4. 人群内性别，年龄及经济生活状况 5. 调查年份—每个季节各一次，至少春，秋，膳食调查3~5天，不包括节假日 如：2002年中国居民营养与健康状况调查的设计 按经济发展水平及类型将全国各县（市、区）划分为大城市、中小城市、一类农村、二类农村、三类农村、四类农村，共6类地区。采用多阶段分层整群随机抽样，在全国31个省、自治区、直辖市的132个县（区、市），共抽取71971户（城市24034户、农村47937户），243479人（城市68656人、农村174 823人）。为保证孕妇、乳母、婴幼儿和12岁及以下儿童的调查人数，以满足各组样本量的要求，在样本地区适当补充调查人数，本次调查总计272023人。 营养调查的内容 膳食调查 人体营养水平的生化分析 营养缺乏病的临床检查 人体测量的资料分析
（一）膳食调查 目的：调查对象在一定时间内摄取的能量和各种营养素的数量和质量，评定营养需要得到满足的程度。 营养指导和咨询的依据；制定政策的依据 方法： 1. 称重法：食物称重，计算营养素平均摄入量，时间为3~7天。 步骤：1）准确记录每餐各种食物和调味品名称；2）准确称取每餐食物的毛重、净重、熟重以及剩余食物重量；3）计算生熟比；4）将消耗的食物分类、综合，求得每人每天的生食物消耗量；5）计算每人每天的营养素摄入量（食物成分表，生食物的重量） 称重食物生熟比值换算法 每人每天各种食物的平均摄取量 =总消耗量/进餐人数 ?如果进餐人员在年龄、性别、劳动强度差别较大时：混合系数折算法计算“标准人” 每人每天营养素摄入量。 ?标准人：轻体力劳动者的成年男子的能量推荐量（2400kcal）作为1.0，不同年龄、 性别、劳动强度的能量推荐量与标准人比较，计算混合系数。 特点：适用于团体、家庭及个人。能准确地反映被调查单位或个人的膳食摄取情况，但费人力及时间，不适合于大规模的调查工作。 2. 查帐法：适用于有详细伙食帐目的机关、学校、部队、托儿所等集体单位。 查阅一定时期内食堂的食品消耗量，并根据进餐人数，粗略计算每人每天各种食物的平均摄取量。 ?食堂帐目要求：食物的名称和消费量逐日准确记录；对进餐人数应统计准确并按年 龄、性别、工种和班次登记；自制的食品要准确登记。 ?家庭：调查开始前登记所有储存以及新近购进的食物种类和数量，调查结束时称重 剩余食物重量，计算调查期间消费的食品总量。 ?特点：简便易行，所费人力少，易于掌握，但不如称量法准确。 3.询问法（24小时膳食回顾法） 通过问答方式来回顾性地了解调查对象过去24小时、48小时或几天实际的膳食摄入状况，对其食物摄入量进行计算和评价的一种方法，是目前最常用的一种回顾膳食调查方法。
中国居民膳食营养素参考摄入量 ChineseDRIsTables (2013年版) 中国营养学会 ChineseNutritionSociety
表1能量和蛋白质的RNIs及脂肪供能比RNIsofenergyandproteinandpercentageofenergyfromfat 0.5~ 80 80 20 20 35~40 1~ 900 800 25 25 2~ 1100 1000 25 25 30~35 3~ 1250 1200 30 30 4~ 1300 1250 30 30 5~ 1400 1300 30 30 6~ 1600 1450 35 35 7~ 1700 1550 40 40 25~30 8~ 1850 1700 40 40 9~ 2000 1800 45 45 10~ 2050 1900 50 50 11~ 2350 2050 60 55 14~ 2850 2300 75 60 25~30 18~ 65 55 20~30 体力活动PAL▲ 轻2250 1800 75 65 中2600 2100 80 70 重3000 2400 90 80 孕早期+0 +0 +0 +0 +300 +450 +0 +0 +0 +0, +15, +30 +0 +0 +0 乳母+0 +500 +0 +25 +0 50~ 65 55 20~30 体力活动PAL▲ 轻Light 2100 1750
重Heavy 2800 2350 65~ 65 55 20~30 体力活动PAL▲ 轻Light 2050 1700 中Moderate 2350 1950 80~ 65 55 20~30 ▲ 注：#各年龄组的能量的RNI与其EAR相同。#TheRNIsofenergyarethesameastheEARs. *为AI，非母乳喂养应增加20%。*AIvalue,add20%tonon-breastfeedinginfants. PAL▲，体力活动水平。Physicalactivitylevel. （凡表中数字缺如之处表示未制定该参考值）
个人膳食调查报告 篇一：个人膳食报告 《食品化学与营养学》 实验报告 题目姓名学号专业班级指导教师实验时间 膳食调查与分析 20XX/11/18-24 实验五膳食调查与评价 一、目的和意义 膳食调查是营养调查的内容之一，通过本实验（实习），掌握最基本的膳食计算方法，学习如何评价膳食的合理性，并提出建议。 二、膳食调查方法 膳食调查有称重法、查帐法、回顾询问法（24h个人膳食询问法）、化学分析法。本实验采用24h个人膳食回顾询问法，对大学生膳食进行计算评价。 三、膳食调查步骤 第一步：以个人为单位记录调查表，可以是自己或某个同学，收集摄食资料，要 求不少于5天（节、假日应除开）。每日应有早、中、晚餐，少数同学还有三餐以外的零食，也应计算在内。
第二步：依次计算完成表1～6各项内容。（表中的表格不够可增加，最好直接用 Excel做表格，以方便后面的计算） 表1每人每日摄入各类食物摄入量登记表；表2每人平均每日营养素摄入量计算表； 表3每人平均每日膳食评价表（与dRis中的Rnis或ais相应值比较）；表4每人平均每日三餐热量分配；表5每人平均每日热量来源；表6每人平均每日蛋白质来源。 表1每人每日摄入各类食物摄入量登记表； 表2每人平均每日营养素摄入量计算表； 表3每人平均每日膳食评价表（与dRis中的Rnis或ais相应值比较）；表4每人平均每日三餐热量分配； 篇二：个人膳食营养调查报告 营养膳食调查报告 一、调查目的 通过24h回顾法对膳 食摄入量进行评估，从而了解在一定时期内个人膳食摄入状况以及膳食结构、饮食习惯，借此来评定正常营养需要得到满足的程度，并制定出适合自己的营养膳食，调整自己的膳食结构。 二、调查方法 采用24h回顾法，记录自己一天摄入的各种食物的种类和数量。按《食物成分表》计算出自己一天中各种营养素和能量的平均摄入值。
前言 人体每天都需要从膳食中获取各种营养物质,来维持其生存、健康和社会生活.如果长期摄取某种营养素不足或过多就可能发生相应的营养缺乏或过剩的危害.为了帮助人们合理的摄入各种营养素,从20世纪早期营养学家就开始建议营养素的参考摄入量,从40年代到80年代，许多国家都制定了各自的推荐的营养素供给量。我国自1955年开始制定"每日膳食中营养素供给量（RDA)"作为设计和评价膳食的质量标准，并作为制订食物发展计划和指导食品加工的参考依据。 随着科学研究和社会实践的发展，特别是强化食品及营养补充剂的发展,国际上自20世纪90年代初期就逐渐开展了关于RDA的性质和适用范围的讨论。欧美各国先后提出了一些新的概念或术语,逐步形成了比较系统的新概念--膳食营养素参考摄入量（Dietary reference intakes）简称DRIs。 中国营养学会研究了这一领域的新进展，认为,制定中国居民DRIs的时机已经成熟.遂于1998年成立了制定中国居民膳食营养素参考摄入量专家委员会(简称Chinese DRIs委员会）及秘书组.并在DRIs委员会的领导下组成5个工作组，分别负责5个部分的营养素和其他膳食成分的工作.经过两年多的努力,于2000年 10月出版了《中国居民膳食营养素参考摄入量Chinese DRIs》.在该书的编著过程中得到了中国达能营养中心的大力协助，罗氏（中国）有限公司提供了很有价值的参考资料。 《中国居民膳食营养素参考摄入量Chinese DRIs》是一部营养学科的专著.它分别对各种营养素的理化性质、生理功能、营养评价及主要食物来源等方面,都进行了系统的论述，尤其对于各营养素的参考值都提供了丰富的科学研究依据,是营养学研究、教学和专业提高的重要参考书.为了适应广大的基层及相关学科的专业人员的需要，DRIs委员会根据原书进行了简编,从中选择对广大读者可能是最有用的内容，适当简化，编写了这个简要本。 《中国居民膳食营养素参考摄入量（简要本）》是针对基层营养卫生工作者及医药、食品、农业、教育等相关学科读者的需要编写的。它简明扼要,便于使用。但欲对有关问题进行深入的了解或研究，还应以原书为依据。 中国营养学会理事长 葛可佑 2001年1月 概要 一、膳食营养素参考摄入量（DRIs,Dietary Reference Intakes） DRIs 是在RDAs基础上发展起来的一组每日平均膳食营养素摄入量的参考值，包括4项内容：平均需要量（EAR）、推荐摄入量（RNI）、适宜摄入量（AI）和可耐受最高摄入量（UL)。
中国居民膳食营养素参考摄入量 1.缩略语 AI ( Adequate Intake ):适宜摄入量 AMDR( Acceptable Macronutrient Distribution Ranges):宏量营养素可接受范围 DFE( Dietary Folate Equivalent):膳食叶酸当量 DRIs( Dietary Reference Intakes):膳食营养素参考摄入量 EAR( Estimated Average Requirement):平均需要量 EER( Estimated Energy Requirement):能量需要量 NCD( Non-communicable Chronic Diseases):非传染性慢性病 NE( Niacin Equivalent):烟酸当量 PI-NCD ( Proposed Intakes for Preventing Non-communicable Chronic Diseases):预防非传染性慢性病的建议摄入量 RAE( Retinol Activity Equivalent):视黄醇活性当量 RDAs( Recommended Dietary Allowances):推荐膳食营养素供给量 RNI( Recommended Nutrient Intake):推荐摄入量 SPL( Specified Proposed Levels):特定建议值a-TE(a -Tocopherol Equivalent) :a -生育酚当量UL( Tolerable Upper Intake Level):可耐受最高摄入量 2.定义 （1）膳食营养素参老摄入量(DRIs)的基本概念 膳食营养素参考摄入量(Dietary Reference Intakes, DRIs),是为了保证人体合理摄入营养素而设定的每日平均膳食营养素摄入量的一组参考值。随着营养学研究的深入发展，DRIs 的内容逐渐增加。初期主要包括四个指标：平均需要量、推荐摄入量、适宜摄入量、可耐受最高摄入量。《中国居民膳食营养素参考摄入量(2013版)》增加了与非传染性慢性病有关的三个指标:宏量营养素可接受范围、预防非传染性慢性病的建议摄入量和特定建议值。 ① 平均需要量(Estimated Average Requirement,EAR) EAR是指某一特定性别、年龄及生理状况群体中的所有个体对某种营养素需要量的平均值。按照EAR水平摄入营养素，根据某些指标判断可以满足这一群体中50%个体需要量的水平，但不能满足另外50%个体对该营养素的需要。 EAR是制定RNI的基础，由于某些营养素的研究尚缺乏足够的人体需要量资料，因此并非所有营养素都能制定出EAR。 ①推荐摄入量(Recommended Nutrient Intake,RNI) RNI是指可以满足某一特定性别、年龄及生理状况群体中绝大多数个体(97%?98%)需要量的某种营养素摄入水平。长期摄入RNI水平，可以满足机体对该营养素的需要，维持组织中有适当的营养素储备和机体健康。RNI相当于传统意义上的RDA。RNI的主要用途是作为个体每日摄入该营养素的目标值。 RNI是根据某一特定人群中体重在正常范围内的个体需要量而设定的。对个别身高、体重超过此参考范围较多的个体，可能需要按每千克体重的需要量调整其RNI。 能量需要量(Estimated Energy Requirement, EER)是指能长期保持良好的健康状态、维持良好的体型和机体构成以及理想活动水平的个体或群体，达到能量平衡时所需要的膳食能量摄入量。 群体的能量推荐摄入量直接等同于该群体的能量EAR,而不是像蛋白质等其他营养素那样等于EAR加2倍标准差。所以能量的推荐摄入量不用RNI表示，而直接使用EER来
膳食营养素摄入量计算 1. 某机关食堂，早 餐有30人进餐，午餐有50人进餐，晚餐有20人进餐，三餐功能比为30%、40%、30%，计算总人日数？ 30×30%+50×40%+20×30%=35人日 2. 某人一周之内在家中用早餐7次，午餐5次，晚餐4次，其餐次比为0.2、0.4、0.4，计算个人总人日数？ 7×0.2+5×0.4+4×0.4=5人日 3. 某食堂早餐用餐人数100人，午餐120人，晚餐80人，每餐能量分别为600kcal、1000kcal、800kcal，计算总人日数？ 三餐热能比：早餐=600/（600+1000+800）=25% 午餐=1000/（600+1000+800）=42% 晚餐=800/（600+1000+800）=33% 总人日数=100×25%+120×42%+80×33%=101.8人日 4.某食堂早、午、晚餐用餐人数分别为200人、280人、160人，每餐能量分别为600kcal、1000kcal、800kcal，计算总人日数？若全部为男性，其中早、午、晚餐轻体力劳动者100、180、80人，早、午、晚餐中体力劳动者60、50、30人，早、午、晚餐重体力劳动者40、50、50人，计算混合系数？若平均每人每日摄入蛋白质82g，计算标准人每日蛋白质摄入量？1）三餐热能比：早餐=600/（600+1000+800）=25% 午餐=1000/（600+1000+800）=42% 晚餐=800/（600+1000+800）=33% 计算折合系数：以轻体力活动男性为标准人，轻体力男性折合系数为1，中体力男性折合系数为2700/2400=1.125，重体力活动男性折合系数为3200/2400=1.33 总人日数=200×25%+280×42%+160×33%=50+117.6+52.8=220.4人日 标准总人日数=（100×25%+180×42%+80×33%）×1.0+（60×25%+50×42%+30×33%）×1.125+（40×25%+50×42%+50×33%）×1.33=127×1.0+45.9×1.125+47.5×1.33=127+51.6+63.2=241.8人日 混合系数=标准总人日数/总人日数=241.8/220.4=1.097 2）标准人每日蛋白质摄入量=平均每人每日摄入蛋白质/混合系数=82/1.097=74.7g 试题1、某膳食调查的人群由三类人员组成，其中能量RNI为3200kcal的有12人，3100kcal 的有10人，2600kcal的有6人，全部人均进行了2天的膳食调查，该人群的蛋白质平均摄入量为80g/人?日。（15分） 1、计算该人群中三种不同能量需要的亚人群的折合标准人系数 2、计算该人群的混合系数 3、计算该人群折合标准人的蛋白质摄入量。 参考答案: 1、各亚人群的折合标准人系数=能量供给量（kcal）/2400 kcal （1）摄入能量3200Kcal人群折合系数：3200kcal / 2400kcal＝1.33 （2）摄入能量3100Kcal人群折合系数：3100kcal / 2400kcal＝1.29 （3）摄入能量2600kcal人群折合系数：2600kcal / 2400kcal＝1.08 2、计算该人群的混合系数=＝∑（折合系数×人日数）/总人日数： 混合系数=（1.33×12×2＋1.29×10×2＋1.08×6×2）÷（12×2＋10×2＋6×2）＝1.26 3、计算该人群折合标准人的蛋白质摄入量=人均蛋白质摄入量/混合系数
附件2: 中国居民膳食（部分）营养摄入量指标1.部分微量元素的推荐摄入量（RNIs）或适宜摄入量（AIs）：
表2.部分维生素的推荐摄入量（RNIs）或适宜摄入量（AIs） 注： μgRE表示"微克视黄醇当量",是一种药剂单位。1μg视黄醇当量＝1μg视黄醇(VA)＝3.3IU（国际单位）视黄醇(VA)＝6μgβ-胡萝卜素。 联合国粮农组织(FAO)及WHO建议维生素A供给量1～15岁时为300～725μg/d,青春期、成人、孕妇750μg/d,乳母1200μg/d; 我国供给量标准与其相近.怀孕动物使用大剂量维生素A,胎儿可发生多种畸形;故临床使用较大剂量维生素A时,应在医生的指导下进行. μgDFE表示“膳食叶酸当量”。由于食物叶酸与合成的叶酸补充剂生物利用程度不同，美国FNB提出叶酸的摄入量应以膳食叶酸当量（DFE）表示。由于食物叶酸的生物利用度仅为50%，而叶酸补充剂与膳食混合时生物利用度为85%，比单纯来源于食物的叶酸利用度1.7倍，因此DFE的计算公式为：DFE（μg）=膳食叶酸μg+（1.7x叶酸补充剂μg） 例如：来源于水果、蔬菜、肉类、豆类及奶制品食物的叶酸共250μg；来源于叶酸补充剂和强化食品的叶酸共200μg，则总叶酸摄入量为250+1.7x200=590μgDFE。 mgNE表示尼克酸（烟酸）当量，烟酸当量（mgNE）=烟酸（mg）+1/60色氨酸（mg）
3.某些微量营养素的最高摄入量（ULs） 注：（1）表中空格处表示没有限定值。 （2）由于尚无VB2 毒性的报道，因此现无VB2的UL值，曾有人提出参考最高摄入量为200mg/d。 说明： 为了保持健康及活跃的生活，人类必须每天从膳食中获取各种各样的营养物质。个体对某种营养素的需要量可能随年龄、性别和生理状况而异。成年人需要营养素来维持体重及保障机体功能。儿童青少年除了维持外还需要更多营养素满足生长发育的需要。妊娠和哺乳的妇女需要额外的营养素，以保证胎儿及母体相关组织增长和泌乳的需要。 人体需要的各种营养素都需从饮食中获得，因此必须科学的安排每日膳食以提供数量及质量适宜的营养素。如果某种营养素长期供给不足或过多就可能产生相应的营养不足或营养过多的危害。 为了帮助个体和人群安全的摄入各种营养素，避免可能产生的营养不良或营养过多的危害，营养学家根据有关营养素需要量的知识，提出了适用于各类人群的膳食营养素参考摄入量（DRIs）。 推荐膳食营养素参考摄入量不是一成不变的。随着科学知识的积累及社会经济的发展，对建议的营养素参考摄入量应当及时进行修订以适应新的认识水平和应用需求。不同的国家，在不同的时期，针对各自的特点和需要使用了一些不同的概念或术语，丰富和推动了这一领域的研究和发展。 什么是DRIs？ 人体需要的各种营养素都需从饮食中获得，因此必须科学的安排每日膳食以提供数量及质量适宜的营养素。如果某种营养素长期供给不足或过多就可能产生相应的营养不足或营养过多的危害。 为了帮助个体和人群安全的摄入各种营养素，避免可能产生的营养不良或营养过多的
睿琪·柏园幼儿园膳食调查和营养评估 膳食调查方面(尤其是在幼儿园内作膳食调查)，主要希望了解以下几个与膳食评价有重要关系的问题。 1、每日所供给的食物量，是否满足幼儿一日所需要的热量和营养素，这就是了解各种营养素和热能摄入量。 2、每日食物的内容怎样调配，这从每天的食谱中可以看得出来。 3、幼儿发育的体格是否良好，经体格检查，尤其身高、体重等形态指标的测量以及营养缺乏病和调查中可以评价。 4、饮食制度是否合适(间隔几小时一餐) (二) 调查的对象与范围： 选择调查的对象必须有代表性。幼儿园进行膳食调查时，要选择性质大致相同的类型(全托制或日托制)，年龄大致相同，可分3-5岁、5-7岁，这样划分可以按规定的营养标准作比较，每月、每日的伙食费也要相似，同时还可以在一个地区选择两个有代表性的幼儿园作比较。选择范围可分两种：一种是不分年龄，作全园性的调查，也按组分为3-5岁、5-7岁；另一种是抽样调查，就是在同年龄级内，选择小数儿童作全面调查。 二、每天食物登记表(表二) （一）调查时先要问明当日食谱，然后将每餐所吃主副食品名称和生熟重量记录于“食物名称”、“生食总重量(斤)”、“熟食总重量(斤)”栏内。在用餐完毕后称剩余食物的重量，记录于“剩余量(斤)”栏内。 （二）生／熟比例＝该种食物烹调前生重量／烹调后熟重量 （三）实际食入熟食量（斤）＝熟食总重量－剩余量 （四）实际食入生食量（斤）＝实际食入熟食量×生／熟比例 （五）折克单位＝实际食入生食量×500（注：折克单位保留2位小数） 三、每人每日营养摄入量计算（表三） （一）类别：如谷类、鱼类、果类等等（请参考“常用食物营养成份表”）将食品名称按类别填写于“类别”栏内，每类留一栏作该类小计。 （二）重量：即平均每人每日食物摄入量（克） （三）平均每人每日食物摄入量（克）＝该种食物摄入量总和（克）÷调查天数÷总人日数 （四）各种食物中各种营养量的计算：在：“常用食物营养成份表”上查食物成份。 某种食物中的某种营养量＝该种食物摄入量×每100克该种食物中某种营养素的量÷100 （五）各种营养素摄入量＝不同食物中同种营养素摄入量之和（克） 注：表三（每人每日营养摄入量计算）的各项统一小数位，热量、钙、磷、维生素A 等用整数，铁、蛋白质、脂肪、糖类用小数点后一位数、胡萝卜素、硫胺素、核黄素、尼克酸、维生素C等小数后两位数。 （四）各种食物中各种营养量的计算：在：“常用食物营养成份表”上查食物成份。 某种食物中的某种营养量＝该种食物摄入量×每100克该种食物中某种营养素的量÷100 （五）各种营养素摄入量＝不同食物中同种营养素摄入量之和（克）
幼儿园膳食营养计划 年龄组成 人数人数人数 年龄 组 男女年龄 组 男女年龄组男女1岁~ 3岁~ 5岁~ 24 26 2岁~ 4岁~ 38 34 6岁~ 13 12 平均每人每日营 养素标准供给量 热能（kcal）蛋白质（克）脂肪（克）碳水化合物（克） 1506 51 46 222 用餐类型：早餐中餐午点 品名4-6岁组 食 物g 粮食 牛奶豆浆(m 1) 豆类(以豆腐干计) 鱼、肉、禽、脏腑类 蛋 蔬莱 水果 食油 耱 158 175 18 52 18 175 70 14 14 营养成分蛋白质 (g) 脂肪 (g) 碳水化合物 (g) 热量 (kca 1) 36 32 155 1052
幼儿园每周带量食谱 年学期第周月日至月日单位×××幼儿园所属医院:市保健院 星期一 1人量 (克) 星期二 1人量 (克) 星期三 1人量 (克) 星期四 1人量 (克) 星期五 1人量 (克) 早餐三鲜濑扮 瘦肉 20 胡萝卜 30 冬菇 10 濑粉 50 油 4 玉米麦片粥 香肠卷 玉米 10 麦片 10 糖 6 面粉 30 香肠 30 油 4 豆芽肉丝 炒米扮 白莱汤 绿豆芽 l0 胡萝卜 20 瘦肉 20 米粉 50 小白菜 30 油 6 鱼片猪红粥 馒头 鱼片 20 猪红 l0 大米 10 油 4 面粉 30 糖 6 海带香干 汤面 海带 l5 香干 30 面条 50 油 4 课 闻 餐 苹果苹果 60 雪梨雪梨 70 橘子橘子 70 苹果苹果 60 雪梨雪梨 70 午五彩鸡丁 炒菜心鸡肉 20 香干 10 青瓜 20 胡萝卜 10 菜心 50 茄汁虾仁 鱼肉饼 炒苋莱 虾仁 5 鱼肉 40 苋莱 100 猪骨 50 粉葛 40 番茄炒鸡蛋 鱼头豆腐汤 蕃茄 60 鸡蛋 40 鱼头 30 豆腐 30 芥莱 50 四季豆炒 猪肝 南瓜猪骨 四季豆 40 猪肝 30 南瓜 30 猪骨 50 海带 30 草菇豆腐 肉未 芥菜蛋花汤 瘦肉 20 豆腐 50 草菇 20 芥菜 80 鸡蛋 10 2
膳食营养素摄入量计算和评价 一、举例：某65岁老年女性的一日食谱如下： 早餐鲜牛奶一杯（200g），馒头一个（小麦标准粉100g） 中餐米饭（粳米，标一100g），猪肉炒芹菜（猪腿肉100g，芹菜250g，酱油 10g，大豆油6g，盐2g） 晚餐米饭（粳米，标一100g），生菜豆腐汤（生菜100g，豆腐100g，大豆油 6g，盐2g），清蒸鲈鱼（200g） 所食用食物的成分表（100g可食部含量） 食物名称食部（%） 能量 (kcal ) 蛋白质 (g) 脂肪 (g) 碳水 化物 (g) 维生素 A (μgRE) 硫胺 素 (mg) 维生 素C (mg) 钙 (mg) 铁mg 牛奶100 54 24 1 104 面粉100 344 0 0 0 14 粳米100 346 0 0 0 29 猪肉 （腿） 100 190 3 0 6 芹菜67 20 57 8 80 酱油100 66 0 0 27 大豆 油 100 900 0 0 0 1
1. 根据上述食谱，计算该对象一日能量及营养素摄入量 ： （食物中营养素的量=食物摄入量×可食部重量比例/100×每100g 食物中含该营养素的量/100） 盐 100 0 0 0 0 0 0 0 22 生菜 94 13 298 13 34 豆腐 100 81 0 0 164 鲈鱼 58 100 19 138 食物名称 摄入量 能量(kcal) 蛋白质 (g) 脂肪(g) 碳水化物(g) 维生素A (μgRE) 硫胺素(mg) 维生素C (mg) 钙(mg) 铁mg 牛奶 200 54×2=10 8 ×2=6 ×2= ×2= 24×2=48 ×2= 1×2=2 104×2 =208 ×2= 面粉 100 344 0 0 0 14 粳米 100 346 0 0 0 29 猪肉（腿） 100 190 3 0 6 芹菜 250 20××= ××= ××= ××= 57××= ××= 8××= 80××= 134 ××= 酱油 10 66×= ×= ×= ×= 0 ×= 0 27×= ×= 大豆油 6 900×=54 0 ×= ×= 0 0 0 1×= ×= 盐 2 0 0 0 0 0 0 0 22×= ×= 粳米 100 346 0 0 0 29 生菜 100 13×= ×= ×= ×= 298×= ×= 13×= 34×= ×= 豆腐 100 81 0 0 164 鲈鱼 200 100×2×=116 ×2×= ×2×= 0 19×2×= ×2×= 0 138×2 ×= ×2×= 大豆油 6 900×=54 0 ×= ×= 0 0 0 1×= ×= 盐 2 0 0 0 0 0 22×= ×= 合计
D R I s中国居民膳食参 考摄入量2013
中国居民膳食营养素参考摄入量Chinese DRIs Tables (2013年版) 中国营养学会 Chinese Nutrition Society
表1 能量和蛋白质的RNIs 及脂肪供能比 RNIs of energy and protein and percentage of energy from fat 0.5~ 80 80 20 20 35~40 1~ 900 800 25 25 2~ 1100 1000 25 25 30~35 3~ 1250 1200 30 30 4~ 1300 1250 30 30 5~ 1400 1300 30 30 6~ 1600 1450 35 35 7~ 1700 1550 40 40 25~30 8~ 1850 1700 40 40 9~ 2000 1800 45 45 10~ 2050 1900 50 50 11~ 2350 2050 60 55 14~ 2850 2300 75 6 25~30 18~ 65 55 20~30 体力活动PAL ▲ 轻Light 2250 1800 75 65 中Moderate 2600 2100 80 70 重Heavy 3000 2400 90 80 孕早期 孕中期 孕晚期 +0 +0 +0 +0 +300 +450 +0 +0 +0 +0, +15, +30 +0 +0 +0 乳母Lactating mothers +0 +500 +0 +25 +0 50~ 65 55 20~30 体力活动PAL ▲ 轻Light 2100 1750 中Moderate 2450 2050 重Heavy 2800 2350 65~ 65 55 20~30 体力活动PAL ▲ 轻Light 2050 1700 中Moderate 2350 1950 80~ 65 55 20~30 ▲
荷花镇童乐幼儿园儿童膳食 调查和营养评估 膳食调查方面(尤其是在幼儿园内作膳食调查)，主要希望了解以下几个与膳食评价有重要关系的问题。 1、每日所供给的食物量，是否满足儿童一日所需要的热量和营养素，这就是了解各种营养素和热能摄入量。 2、每日食物的内容怎样调配，这从每天的食谱中可以看得出来。 3、幼儿发育的体格是否良好，经体格检查，尤其身高、体重等形态指标的测量以及营养缺乏病和调查中可以评价。 4、饮食制度是否合适 一、调查的对象与范围： 选择调查的对象必须有代表性。幼儿园进行膳食调查时，要选择性质大致相同的类型，年龄大致相同，这样划分可以按规定的营养标准作比较。 二、每天食物登记表 （一）调查时先要问明当日食谱，然后将每餐所吃主副食品名称和生熟重量记录于“食物名称”、“生食总重量(斤)”、“熟食总重量(斤)”栏内。在用餐完毕后称剩余食物的重量，记录于“剩余量(斤)”栏内。（二）生／熟比例＝该种食物烹调前生重量／烹调后熟重量
（三）实际食入熟食量（斤）＝熟食总重量－剩余量 （四）实际食入生食量（斤）＝实际食入熟食量×生／熟比例（五）折克单位＝实际食入生食量×500（注：折克单位保留2位小数） 三、每人每日营养摄入量计算 （一）类别：如谷类、鱼类、果类等等将食品名称按类别填写于“类别”栏内，每类留一栏作该类小计。 （二）重量：即平均每人每日食物摄入量（克） （三）平均每人每日食物摄入量（克）＝该种食物摄入量总和（克）÷调查天数÷总人日数 （四）各种食物中各种营养量的计算：在：“常用食物营养成份表”上查食物成份。 某种食物中的某种营养量＝该种食物摄入量×每100克该种食物中某种营养素的量÷100 （五）各种营养素摄入量＝不同食物中同种营养素摄入量之和（克）（六）各种食物中各种营养量的计算：在：“常用食物营养成份表”上查食物成份。 某种食物中的某种营养量＝该种食物摄入量×每100克该种食物中某种营养素的量÷100 （七）各种营养素摄入量＝不同食物中同种营养素摄入量之和（克）