Professional Documents
Culture Documents
PPT5
PPT5
Hadi Riyadi
Kuliah 5
Departemen Gizi Masyarakat
Fakultas Ekologi Manusia
Institut Pertanian Bogor
2020
DIETARY
REFERENCE
INTAKES
LEARNING OBJECTIVE
Mahasiswa mampu menjelaskan
kebutuhan gizi, latar belakang,
pengertian, komponen, dan
penggunaan DRI.
Kebutuhan Gizi
Untuk memahami DRI perlu
pengetahuan kebutuhan (requirement)
gizi
Kebutuhan adalah level intik zat gizi
terendah yang dikonsumsi secara terus
menerus yang akan dapat
mempertahankan taraf gizi tertentu
pada seseorang berdasarkan kriteria
kecukupan gizi yang telah ditetapkan.
Faktor-faktor yang mempengaruhi
kebutuhan gizi
Usia : masa bayi, kanak-kanak, remaja (pubertas),
dewasa, manula
Ukuran tubuh : semakin besar ukuran tubuh
semakin tinggi kebutuhan gizi
Jenis kelamin : kebutuhan gizi laki-laki lebih
besar daripada perempuan
Keadaan fisiologis : masa kehamilan, menyusui,
status gizi
Keadaan sakit dan penyembuhan : perlu
makanan bergizi untuk penyembuhan; penyakit
meningkatkan kebutuhan gizi
Kegiatan fisik : semakin aktif, semakin banyak
energi yang diperlukan
Suhu lingkungan
Mutu makanan
Gaya hidup : alkohol, merokok
Dietary Reference Intakes (DRIs)
• Background
• Purposes
• Definitions
• Characteristics
• Uses
• Timeline
Background
• Recommended Dietary Allowances (RDAs)
1st ed.: 1941 10th ed.: 1989
• Primary goal: prevent diseases caused by
nutrient deficiencies
• Developed for healthy groups, not
individuals
• DRIs replace periodic revisions of RDAs
Recommended Dietary Allowances
1941 1989
Energy Energy
Protein Protein
2 minerals (Ca, Fe) 7 minerals (Ca, Fe, P, Mg, Zn,
I, Se)
6 vitamins (A, C, D, thiamin, 11 vitamins (A, C, D, thiamin,
riboflavin, niacin) riboflavin, niacin, E, K, B6,
B12, folate)
Safe and adequate daily
dietary intakes (biotin,
panthothenate, Cu, Mn, F, Cr,
Mo)
Perubahan di Era 1990-an
Background (cont.)
Health Canada
From traditional to new concepts in nutrition
A new frontier in nutrition science:
Concepts are changing significantly
Adequate Optimal
nutrition nutrition
Danger
of toxicity
Marginal
Tolerable
Upper Intake
Safety
Level
Safety
RDA or AI
RDA Estimated
Marginal Average
Requirement
Danger Danger
of
deficiency
Naive Accurate
view view
Central question of human
nutrition science :
• What substances in food (and in what
amounts) are necessary for good health ?
• Traditional endpoints
– Growth and development
– Successful reproduction
– Prevention of deficiency diseases
What else constitutes good
health ?
• Observational epidemiology, clinical
trials link diet to increased risk of
chronic diseases of aging.
• Epidemiology and nutrient-gene
expression studies are refining a new
concept : Deveopment origins of health
and diseases.
Free Radicals and Anti-Oxidants
unstable oxygen molecules can be formed from sunlight, smoking, and pollution
Antioxidant Power and Your Cells –
Staying Healthy
Endpoints for defining good
health
• Growth and development
• Successful reproduction
• Prevention of deficiency diseases
• Prevention of chronic diseases of aging
• Prevention of toxicity
• Maintenance of physiological function
What are the purposes
of the DRIs?
• To maintain nutritional adequacy
• To promote health
• To reduce risk of chronic disease
• To provide a measure for evaluating
inadequacy and/or excess
• To assess intakes as distributions
– Across population groups
– In individuals
• To plan diets 18
Why are the DRIs important to
nutrition, food, and agriculture policy ?
• Dietary assessment
• Planning and procuring food supplies
• Food fortification and supplementation
policies
• Planning education programs
• Planning and evaluating food assistance
• Food labeling policies
• Agricultural policies
Why do we need to assure
nutrient quality?
• To impact nutritional status
• To impact health
• To impact functionality
• To impact quality of life
• To assist older adults in making healthy
choices
• To measure & document outcomes
20
Definitions
What are the Dietary Reference
Intakes (DRIs)?
• Reference values of nutrients,
primarily used by nutrition & health
professionals
• Basis for
– assessing & planning
diets of healthy people
– nutrition &
food programs
22
Dietary Reference Intakes (DRIs)
Collective term that includes nutrient-
based dietary reference values
• Estimated Average Requirement (EAR)
• Recommended Dietary Allowance (RDA)
• Adequate Intake (AI)
• Tolerable Upper Intake Level (UL)
• Acceptable Macronutrient Distribution
Range (AMDR)
What are characteristics
of the DRIs?
• Separate values
– men
– women
• New values
– 51 - 70 yrs
– 70+ yrs
• Deficiency disease reduction
• Chronic disease reduction
• Safe upper levels of intake 25
Who established the DRIs?
26
What are the different
DRI values?
• Estimated Average Requirement: EAR
• Recommended Dietary Allowance: RDA
• Adequate Intake: AI
• Tolerable Upper Intake Level: UL
27
What is a nutrient requirement?
28
What is the EAR?
Estimated Average Requirement
• Nutrient intake to meet the
requirement of half the healthy
people of an age & gender
• The MEDIAN (Think bell curve)
• Basis for establishing an RDA
29
EAR
Number
of people
EAR
Daily requirement for nutrient
What is the RDA?
Recommended Dietary Allowance
• Nutrient intake to meet the
requirement for nearly all (97-98%)
healthy people of an age & gender
• Derived from an EAR
• RDA = EAR + 2 standard deviations
• or RDA = EAR + 2 (10%)
32
RDA
Number
of people
EAR RDA
Daily requirement for nutrient
Energy RDA =EAR
What is the AI?
Adequate Intake
• Nutrient intake of healthy people
assumed to be adequate
• Used when an RDA cannot be established
• Insufficient data to determine an EAR
• Based on observed intakes, experimental
data, etc.
35
Dietary Reference Intakes DRI
RDA’s AI’s
Minerals Minerals
Cu,I,Mg,Mo,P,Se,Zn Ca,Cr,F,Mn,
Energy and
Energy and Building blocks
Building blocks Fiber, Fat, Linoleic acid
Carbohydrate,Proteins
Figure. Dietary Reference Intakes for
vitamins and minerals in individuals one
year and older. EAR = Estimated
Average Requirement; RDA =
Recommended Dietary Allowance; AI =
Adequate Intake; UL = Tolerable Upper
Intake Level; — = no value established.
What is the UL?
Tolerable Upper Intake Level
• Highest daily nutrient intake likely to pose
no risk of adverse health effects to almost
all the general population
• Applies to daily use
• Not a recommended level
– No established benefits of higher level
– Increased risks at higher intakes
38
Tolerable Upper Intake Level
• ULs vary among nutrients:
– some apply to intake from all sources -- food,
fortified food, supplements, water (eg, calcium,
vitamin D)
– some apply to intake from synthetic forms
alone (eg, folic acid, niacin, magnesium)
– not all nutrients have ULs established presently
(eg, vitamin B12)
39
EAR:
Setting DRIs UL:
50% risk of Upper Limit with no
RDA:
inadequacy risk of inadequacy
2-3% risk
or adverse effects
of inadequacy
Nutrient AMDR
Carbohydrate 45 - 65%
Fat 20 - 35%
Protein 10 - 35%
Dietary Reference Intakes
Why use the DRIs?
• Increase accuracy of dietary
assessments, taking care that :
– dietary data are complete,
– portions are correctly specified,
– food composition data are accurate,
– methodologies & plans for sampling
group intakes are appropriate.
44
Use of DRIs:
Assessing Intakes
• For an Individual • For a Group
EAR: Use to examine the probability EAR: Use to examine the prevalence
that usual intake is inadequate of inadequate intakes within a
RDA: Usual intake at/above this group
level has low probability of RDA: Do not use to assess intakes of
inadequacy groups
AI: Usual intake at/above this level AI: Mean usual intake at/above this
has low probability of inadequacy level implies a low prevalence of
UL: Usual intake above this level inadequate intakes
may place individual at risk of UL: Use to estimate % population at
adverse effects from excessive potential risk of adverse effects
nutrient intake from excessive nutrient intake
45
RDA is inappropriate for assessing
groups
• RDA: intake levels that exceed requirements
of 97–98 % of all individuals when
requirements in the group have a normal
distribution
• Thus, RDA: not a cut-point for assessing
nutrient intakes of groups-- serious
overestimation of the proportion of the group
at risk of inadequacy would result
46
Group Prevalence of
Inadequate Intakes
• What proportion of
individuals in a
group have usual
intake below
requirements?
48
Impact of Additional Days of
Observation in Variance in Intake
“Usual intakes” observed
Percent of Individuals
EAR
1-day observations
49
Intake of nutrient (amount/day)
Planning for groups
or individuals
• Dietary Reference Intakes for
Planning: publication in July 2002.
• RDAs can be used in planning for
groups or individuals – but not in
assessing adequacy of intake.
50
Uses of DRIs (cont.)
• Diet Planning
– Individual
• aim for RDA & AI
• use UL as guide to limit intake
– Group
• use EAR to set goals for intake of group
RDA UL
Men (age 19-30) 90mg 3,000mg
Women (age 19-30) 75mg 2,000mg
Vitamin C intake
UL Men
UL Women
1.Thiamin (B1)
2.Riboflavin (B2) Coenzymes:
3.Niacin Catalysts in
Biochemical Pathways
4.Vitamin B6
5.Folic Acid
6.Vitamin B12
7.Pantothenic Acid
8.Biotin
B vitamins
• Busily work in pathways
– all throughout the body
• Indispensable for metabolism
– act as coenzymes
B Vitamins Coenzyme Roles
Vitamin Thiamin Riboflavin Niacin B6 Folate Pantothenic Biotin B12
Acid
TPP FAD FMN NAD NADP PLP THF CoA Biotin B12
Coenzyme
ENERGY
From: Nutrition, An Applied Approach, Thompson and Manroe, 2005
RDI Dose Comparison
14/16 5/5
Women
1.5
Men
1.3 1.3 1.3
1.2
1.1 1.1
Milligrams
0.0024 0.03
0.0024 0.03
0
id
n
in
2
B6
n
te
in
vi
B1
ci
Ac
ot
m
la
la
ia
Bi
Fo
ia
of
c
Th
ni
ib
he
R
ot
nt
Pa
Thiamin (Vitamin B1)
RDA 1.2mg men/1.1mg women
• Acts primarily as a coenzyme
in reactions that release
energy from carbohydrate
60
50
RDI (mg) Women
40 No known 35
adverse RDI (mg) Men
30 effects
UL (mg)
20
10
1
0
id
in
in
2
B6
in
te
in
B1
Ac
v
ot
c
m
la
la
ia
Bi
Fo
ia
of
c
Th
i
ib
en
R
h
ot
nt
Pa
Toxicity
• Thiamin NONE
• Riboflavin NONE
Nausea, headaches, cramps, ulcer
• Niacin
• Pantothenic Acid NONE
• Biotin NONE
Depression, fatigue, headaches,
• Vitamin B6 nerve damage, walking problems
Diarrhea, insomnia, irritability
• Folic Acid
NONE
• Vitamin B12
Folate, Folic Acid
recommendations
• All women of child bearing age should
take:
– 400 micrograms of folic acid
– 4 mg if history of seizure disorders
• (should see physician)
• 50% of all pregnancies are unplanned
• Deficiency : Neural tube defects.
Folic Acid Sources
Adult DRI (RDA)=400mg
Choline
PROTEIN
Converted in
Methionine body Choline
(essential aa) In 1998 made a
conditionally
essential nutrient
Lecithin
from foods
Choline AI
550
425
In 2001, nutrient
content claim:
‘good source’
Women Men
Choline
Phytonutrients in Foods
• Phytochemicals
physiologically active compounds found in
plants that are not essential nutrients but
that appear to help promote health and
reduce risk for cancer, heart disease, and
other conditions.
Repair damage
Vitamin C
• Donates electrons to
free radicals
• EAR
– women: 60 mg/day
– men: 75 mg/day
1970s
2005
2015
1950s-1960s
AKG Indonesia 2012
Tabel 1. Angka Kecukupan Energi, Protein, Lemak, Karbohidrat, Serat dan Air yang dianjurkan
untuk orang Indonesia (per orang per hari
(10 Kolom) BB TB Energi Protein Lemak Omega-6 Omega-3 Karbohidra Serat Air
(kg) (cm) (kkal) (g) (g) (g) (g) t (g) (mL)
(g)
Perempuan 10-12 tahun 600 15 11 35 1,0 1,2 11 4,0 1,2 400 1,8 20 375 50
Perempuan 13-15 tahun 600 15 15 55 1,1 1,3 12 5,0 1,2 400 2,4 25 400 65
Perempuan 16-18 tahun 600 15 15 55 1,1 1,3 12 5,0 1,2 400 2,4 30 425 75
Perempuan 19-29 tahun 500 15 15 55 1,1 1,4 12 5,0 1,3 400 2,4 30 425 75
Perempuan 30-49 tahun 500 15 15 55 1,1 1,3 12 5,0 1,3 400 2,4 30 425 75
Perempuan 50-64 tahun 500 15 15 55 1.0 1,1 10 5,0 1,5 400 2,4 30 425 75
Perempuan 65-80 tahun 500 20 15 55 0,8 0,9 9 5,0 1,5 400 2,4 30 425 75
Perempuan >80 tahun 500 20 15 55 0,7 0,9 8 5,0 1,5 400 2,4 30 425 75
Tambahan Bumil Timester 1 +300 +0 +0 +0 +0,3 +0,3 +4 +1,0 +0,4 +200 +0,2 +0 +25 +10
Tambahan Bumil Trimester 2 +300 +0 +0 +0 +0,3 +0,3 +4 +1,0 +0,4 +200 +0,2 +0 +25 +10
Tambahan Bumil Trimester 3 +350 +0 +0 +0 +0,3 +0,3 +4 +1,0 +0,4 +200 +0,2 +0 +25 +10
Tambahan Busui 6 bln +350 +0 +4 +0 +0,3 +0,4 +3 +2,0 +0,5 +100 +0,4 +5 +75 +25
Tambahan Busui 6 bln kedua +0 +0,3 +0,4 +3 +2,0 +0,5 +100 +0,4 +5 +75 +25
Tabel 3. Angka Kecukupan Vitamin Larut Air yang dianjurkan untuk orang Indonesia (per orang per
hari)
(13 kolom) Besi Fluor Fosfor Iodium Kalium Kalsium Kromium Magnesium Mangan Natrium Selenium Seng Tembaga
(mg) (mg) (mg) (mcg) (mg) (mg) (mcg) (mg) (mg) (mg) (mcg) (mg) (mcg)
Bayi 0–6 - - 100 90 500 200 - 30 - 120 5 - 200
Bayi 7 – 11 7 0.4 250 120 700 250 6 55 0,6 200 10 3 220
Anak 1-3 tahun 8 0.6 500 120 3000 650 11 60 1,2 1000 17 4 340
Anak 4-6 tahun 9 0.9 500 120 3800 1000 15 95 1,5 1200 20 5 440
Anak 7-9 tahun 10 1.2 500 120 4500 1000 20 120 1,7 1200 20 11 570
Laki-laki 10-12 13 1.7 1200 120 4500 1200 25 150 1,9 1500 20 14 700
Laki-laki 13-15 19 2.4 1200 150 4700 1200 30 200 2,2 1500 30 18 800
Laki-laki 16-18 15 2.7 1200 150 4700 1200 35 250 2,3 1500 30 17 890
Laki-laki 19-29 13 3.0 700 150 4700 1100 35 350 2,3 1500 30 13 900
Laki-laki 30-49 13 3.1 700 150 4700 1000 35 350 2,3 1500 30 13 900
Laki-laki 50-64 13 3.1 700 150 4700 1000 30 350 2,3 1300 30 13 900
Laki-laki 65-80 13 3.1 700 150 4700 1000 30 350 2,3 1200 30 13 900
Laki-laki >80 tahun 13 3.1 700 150 4700 1000 30 350 2,3 1200 30 13 900
Perempuan 10-12 20 1.9 1200 120 4500 1200 21 155 1,6 1500 20 13 700
Perempuan 13-15 26 2.4 1200 150 4500 1200 22 200 1,6 1500 30 16 800
Perempuan 16-18 26 2.5 1200 150 4700 1200 24 220 1,6 1500 30 14 890
Perempuan 19-29 26 2.5 700 150 4700 1100 25 310 1,8 1500 30 10 900
Perempuan 30-49 26 2.7 700 150 4700 1000 25 320 1,8 1500 30 10 900
Perempuan 50-64 12 2.7 700 150 4700 1000 20 320 1,8 1300 30 10 900
Perempuan 65-80 12 2.7 700 150 4700 1000 20 320 1,8 1200 30 10 900
Perempuan >80 tahun 12 2.7 700 150 4700 1000 20 320 1,8 1200 30 10 900
Tambahan Bumil Timester 1 +0 +0 +0 +70 +0 +200 +5 +40 +0,2 +0 +5 +2 +100
Tambahan Bumil Trimester2 +9 +0 +0 +70 +0 +200 +5 +40 +0,2 +0 +5 +4 +100
Tambahan Bumil Trimester3 +13 +0 +0 +70 +0 +200 +5 +40 +0,2 +0 +5 +10 +100
Tambahan Busui 6 bln +6 +0 +0 +100 +400 +200 +20 +0 +0,8 +0 +10 +5 +400
Tambahan Busui 6 bln +8 +0 +0 +100 +400 +200 +20 +0 +0,8 +0 +10 +5 +400