Harmonising approaches to realigning dietary recommendations

The papers in this supplement revisit the difficulties of setting reference intakes, particularly for the intakes of micronutrients. As such, they represent an early stage of the European Micronutrient Recommendations Aligned (EURRECA) Network of Excellence's activity addressing children of all ages, adolescents and women during pregnancy and lactation.

One of the drivers for the EURRECA initiative was an awareness of the need to reconcile the extensive differences in approaches taken by different national and international bodies responsible for advising on reference intake values and the concomitant differences in the terminologies used by the panels. These issues had been highlighted, during the burst in the 1980s and early 1990s, of independent activities setting reference intakes. The lack of homogeneity for dietary reference values was seen as a barrier to scientific advancement and, as importantly, as a potential barrier to international labelling and trade. The European Society of Paediatric Gastroenterology, Hepatology and Nutrition's (ESPGHAN) Committee on Nutrition produced a critical commentary (Aggett et al. 1997) on the recommended intakes and highlighted the need for an international appraisal and, possibly, a harmonization of reference values. These proposals were championed by the European Academy of Nutritional Sciences, ESPGHAN and the United Nations University's (UNU) Food and Nutrition Programme. The latter, with support from the Food and Agriculture Organization, World Health Organization and the United Nations Children Fund, organized an international expert review of the approaches used for developing nutrient‐based dietary‐based standards with a view to their harmonization. The papers and conclusions from this workshop's participants were published as a supplement (King & Garza 2007); they cover the general comments made in this editorial. Concepts from this exercise fed into the bidding application for EURRECA, and they provide a good platform for a rethink and reform in addressing the establishment of reference standards for intakes in Europe and elsewhere. Thus, EURRECA has the opportunity to take up the baton in the evolution of nutrient‐based standards.

The ESPGHAN Committee on Nutrition's commentary benefitted from earlier critiques of recommended dietary allowances, particularly those of Harper (1987) and Leverton (1975). The latter titled her commentary as ‘The RDAs are not for amateurs’; the ESPGHAN 1997 comment wondered if they were even for professionals. Probably, they are not for any single professional. The derivation of dietary reference standards challenges and depends on the interdisciplinarity of nutritional science, and the process needs a clear framework for their derivation, which enables the contribution of each discipline to be identified and appropriately incorporated. The papers in this supplement show the need for this. It is difficult effectively to comment on each and to summarize their synergy. They are disparate and too variable in other respects for me to explore their complementarity or, more importantly, to match them against a possible template or approach to setting nutrient‐based dietary standards, such as that proposed by the UNU workshop. In moving forward with this process, one has to live with the present but, at the same time, prepare for a better future in terms of setting reference standards. Currently, the databases for setting standards for micronutrients are little better than they have been in the past; the information is generally opportunistic and seldom in a form to demonstrate, let alone characterize, a dose or exposure–response relationship.

There is a need to appreciate the uncertainties and variabilities of the current values, i.e. to identify our ignorance, rather than try to make sense of the poor quality data that we have. These papers to a large extent show this inadequacy of data, but are in danger of falling to the temptation of still using these data to derive values or to justify a spurious harmonization. Identifying our areas of ignorance and limited knowledge, and agreeing on these and on how to deal with them, would inform future research needs as part of a strategy to setting standards. This is the same knowledge need as that for the justification of some health claims, i.e. systematic good‐quality dose response data using validated realistic outcomes. This basic principle has not been applied universally in assessing all the data in these papers. Nonetheless, they highlight the challenges of assessing external exposure, relating this to internal exposure or burden and to functional efficacy; more so, the papers show the challenges in trying to do this with observational data rather than systematic studies based on a complete appreciation of the specific systemic handling of micronutrients.

This applies particularly to pregnancy and lactation and to growth and development during childhood. There is a need to derive appropriate outcomes for the derivation of nutrient standards for use in these ‘vulnerable’ periods. One hopes very much that this EURRECA activity will be able to make sense of the current uncertainties, to enable it to use information such as that presented here to identify and prioritize knowledge needs and to develop from this a strategy for setting harmonized Average Nutrient Requirements and deriving further Nutrient Intake Values as would be appropriate for the particular and peculiar needs of various populations according to the proposals of the UNU working group (King & Garza 2007).

Conflict of interest

There are no conflicts of interest.