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The AMDR for fat and carbohydrate is estimated to be 20 to 35 and 45 to 65 percent of energy for adults, respectively. These AMDRs are estimated based on evidence indicating a risk for coro-nary heart disease (CHD) at low intakes of fat and high intakes of carbohydrate and on evidence for increased risk for obesity andThe Acceptable Macronutrient Distribution Range (AMDR) for carbohydrates is between 45 and 65 percent. This means that on a 2,000 kilocalorie diet, a person should consume between 225 and 325 grams of carbohydrate each day. According to the IOM not more than 25 percent of total calories consumed should come from added sugars.Carbohydrates Common Names. Carbohydrates, Carbs, Sugars; Recommended Intake. Males & Females ≥ 19 years: 130 g/day; Acceptable Macronutrient Distribution Range (AMDR): 45-65% of energy should come from carbohydrates each day. What's Carbohydrate for? Acts as the main source of energy for the body; Creates an energy reserve with its storageThe AMDR for carbohydrates is between 45-65% of total calories. This means that if a person needs to eat 2,000 calories per day to maintain a healthy... See full answer below. Become a member and...What is the AMDR for carbohydrate? 45-65%. What is the recommended intake of dietary fiber per day? 25 g/day for women, 38 g/day for men. The 2015-2020 Dietary Guidelines recommends that Americans limit their added sugar to no more than 10% of their daily Caloric intake/needs. Calculate the maximum intake of added sugar (in teaspoons) for an

4.7: Carbohydrates and Personal Diet Choices - Medicine

The Acceptable Macronutrient Distribution Range (AMDR) is the calculated range of how much energy from carbohydrates, fats, and protein is recommended for a healthy diet. The AMDR for carbohydrates is between 45% and 65%, which is based off an individual's kilocalorie diet amount. How does the type of carbohydrate impact health?For diabetes meal planning, 1 carb serving is about 15 grams of carbs. This isn't always the same as what you think of as a serving of food. For example, most people would count a small baked potato as 1 serving. However, at about 30 grams of carbs, it counts as 2 carb servings.The AMDR for carbohydrate is 55-70%, for fat is 15-25%, and for protein is 7-20% of the energy intake for adults. The subjects who did not meet the AMDRs for carbohydrate, fat and protein were considered to be the non-AMDR group.Expert Answer AMDR means Acceptable Macronutrient Distribution Ranges. The AMDR range for carbohydrates for adults is 45% to 65%. That means a person should consume 225gms to 325 gms of carbohydrate each day.

Macronutrients - Protein, Carbohydrate & Fat

The AMDR for carbohydrate intake recommended by the FNB:IOM in adults and children is 45-65% of dietary energy intake (FNB:IOM 2002). The intakes were based on the IOM interpretation that there is an increased risk for CHD at high carbohydrate intakes (>65%) and increased risk of obesity with low carbohydrate, high fat intakes (<45%).Carbohydrate— Total digestible RDA based on its a Acceptable Macronutrient Distribution Range (AMDR)a is the range of intake for a particular energy source that is associated with reduced risk of chronic disease while providing intakes of essential nutrients. If an individuals consumed in excess of the AMDR, there is a potential ofCarbohydrates are a crucial fuel source for your brain, which is the only carbohydrate-dependent organ in your body. Recommended Dietary Allowance The Institute of Medicine recommends you get between 45 to 65 percent of your daily calories from carbohydrates.This section should be at least 200 words. • What is meant by the AMDR, and what is this range for carbohydrates? • How does the type of carbohydrate impact health? • What is one negative health impact from carbohydrate intake? • What is one positive health impact from carbohydrate intake? Part B Here is a sample one-day menu for Mr. Brown.What is meant by the AMDR, and what is this range for carbohydrates? -The AMDR is The Acceptable Macronutrient Distribution Range. It is "the range of intake for a particular energy source that is associated with reduced risk of chronic disease while providing intakes of essential nutrients.

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DRI DIETARY REFERENCE INTAKES FOR Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids Panel on Macronutrients, Panel on the Definition of Dietary Fiber, Subcommittee on Upper Reference Levels of Nutrients, Subcommittee on Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes Food and Nutrition Board

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the matter of this report was licensed through the Governing Board of the National Research Council, whose contributors are drawn from the councils of the Na- tional Academy of Sciences, the National Academy of Engineering, and the Institute of Medi- cine. The individuals of the committee responsible for the file had been chosen for their particular competences and with regard for appropriate stability. This project was funded through the U.S. Department of Health and Human Services Office of Disease Prevention and Health Promotion, Contract No. 282-96-0033, TO #4; Health Canada; the U.S. Food and Drug Administration; the National Institutes of Health; the Centers for Disease Control and Prevention; the U.S. Department of Agriculture; the Department of Defense; the Institute of Medicine; the Dietary Reference Intakes Private Foundation Fund, including the Dannon Institute and the International Life Sciences Institute, North America; and the Dietary Reference Intakes Corporate Donorsâ€™ Fund. Contributors to the Fund in- clude Roche Vitamins Inc, Mead Johnson Nutrition Group, and M&M Mars. The views pre- sented on this document are those of the Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its panels and subcommittes and are now not essentially the ones of the investment agencies. Library of Congress Cataloging-in-Publication Data Dietary reference intakes for power, carbohydrate, fiber, fats, fatty acids, ldl cholesterol, protein, and amino acids / Panel on Macronutrients, Panel on the Definition of Dietary Fiber, Subcommittee on Upper Reference Levels of Nutrients, Subcommittee on Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board. p. ; cm. Includes bibliographical references and index. ISBN 0-309-08525-X (pbk.) â€" ISBN 0-309-08537-3 (hardcover) 1. Nutrition. 2. Reference values (Medicine) [DNLM: 1. Nutrition. 2. Diet. 3. Reference Values. ] I. Institute of Medicine (U.S.). Panel on Macronutrients. II. Institute of Medicine (U.S.). Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. QP141.D529 2005 613.2â€"dc22 2004031026 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan house); Internet, http://www.nap.edu. For extra information about the Institute of Medicine, consult with the IOM home page at: www.iom.edu. Copyright 2002/2005 by way of the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been an emblem of lengthy life, healing, and information amongst nearly all cul- tures and religions since the beginning of recorded historical past. The serpent adopted as a logo- sort by way of the Institute of Medicine is a relief carving from historical Greece, now held by way of the Staatliche Museen in Berlin.

â€œKnowing is not sufficient; we should apply. Willing is not enough; we should do.â€ â€" Goethe Advising the Nation. Improving Health.

The National Academy of Sciences is a personal, nonprofit, self-perpetuating society of outstanding students engaged in scientific and engineering research, devoted to the furtherance of science and era and to their use for the general welfare. Upon the authority of the charter granted to it by means of the Congress in 1863, the Academy has a mandate that calls for it to advise the federal executive on clinical and technical issues. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was once established in 1964, beneath the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is self sufficient in its administration and in the choice of its mem- bers, sharing with the National Academy of Sciences the duty for advising the federal executive. The National Academy of Engineering also sponsors engi- neering programs geared toward assembly nationwide needs, encourages training and research, and acknowledges the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine used to be established in 1970 by means of the National Academy of Sciences to protected the services and products of eminent participants of appropriate professions in the examination of policy issues referring to the well being of the public. The Institute acts underneath the responsibility given to the National Academy of Sciences through its congressional charter to be an adviser to the federal govt and, upon its personal initiative, to spot problems with medical care, analysis, and training. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was arranged through the National Academy of Sciences in 1916 to affiliate the vast group of science and era with the Academyâ€™s functions of furthering knowledge and advising the federal executive. Functioning in keeping with general policies decided via the Academy, the Council has develop into the most important running agency of both the National Academy of Sciences and the National Academy of Engineering in providing products and services to the executive, the public, and the clinical and engineering communities. The Council is administered jointly by means of both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

PANEL ON DIETARY REFERENCE INTAKES FOR MACRONUTRIENTS JOANNE R. LUPTON (Chair), Faculty of Nutrition, Texas A&M University, College Station GEORGE A. BROOKS, Department of Integrative Biology, University of California, Berkeley NANCY F. BUTTE, Department of Pediatrics, U.S. Department of Agriculture/Agriculture Research Service Childrenâ€™s Nutrition Research Center, Baylor College of Medicine, Houston, Texas BENJAMIN CABALLERO, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland JEAN PIERRE FLATT, Department of Biochemistry and Molecular Biology, University of Massachusetts Medical Center, Worcester SUSAN K. FRIED, Department of Nutritional Sciences, Rutgers University, New Brunswick, New Jersey PETER J. GARLICK, Department of Surgery, State University of New York at Stony Brook SCOTT M. GRUNDY, Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas SHEILA M. INNIS, BC Research Institute for Childrenâ€™s and Womenâ€™s Health, University of British Columbia, Vancouver DAVID J.A. JENKINS, Department of Nutritional Sciences, University of Toronto, Ontario RACHEL Ok. JOHNSON, Department of Nutrition and Food Sciences, University of Vermont, Burlington RONALD M. KRAUSS, Department of Molecular Medicine, Lawrence Berkeley National Laboratory, University of California, Berkeley PENNY KRIS-ETHERTON, Department of Nutrition, Pennsylvania State University, University Park ALICE H. LICHTENSTEIN, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts FRANK Q. NUTTALL, Department of Medicine, University of Minnesota School of Medicine, Minneapolis PAUL B. PENCHARZ, Departments of Pediatrics and Nutritional Sciences, University of Toronto, Ontario F. XAVIER PI-SUNYER, Department of Medicine, Columbia University, New York WILLIAM M. RAND, Department of Family Medicine and Community Health, Tufts University School of Medicine, Boston, Massachusetts PETER J. REEDS (deceased), Department of Animal Sciences, University of Illinois at Urbana-Champaign ERIC B. RIMM, Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts SUSAN B. ROBERTS, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts v

Staff PAULA R. TRUMBO, Study Director SANDRA SCHLICKER, Senior Program Officer ALICE L. VOROSMARTI, Research Associate KIMBERLY STITZEL, Research Assistant (until January 2001) CARRIE L. HOLLOWAY, Research Assistant GAIL E. SPEARS, Staff Editor SANDRA AMAMOO-KAKRA, Senior Project Assistant MICHELE RAMSEY, Senior Project Assistant (until June 2001) vi

PANEL ON THE DEFINITION OF DIETARY FIBER JOANNE R. LUPTON (Chair), Faculty of Nutrition, Texas A&M University, College Station GEORGE C. FAHEY, Department of Animal Sciences, University of Illinois at Urbana-Champaign DAVID J.A. JENKINS, Department of Nutritional Sciences, University of Toronto, Ontario JUDITH A. MARLETT, Department of Nutritional Science, University of Wisconsin-Madison JOANNE L. SLAVIN, Department of Food Science and Nutrition, University of Minnesota, St. Paul JON A. STORY, Department of Foods and Nutrition, Purdue University, West Lafayette, Indiana CHRISTINE L. WILLIAMS, Department of Pediatrics, Columbia University, New York Consultants LEON PROSKY, Prosky Associates, Rockville, Maryland ALISON STEPHEN, CanTox, Inc., Mississauga, Ontario Staff PAULA R. TRUMBO, Study Director ALICE L. VOROSMARTI, Research Associate KIMBERLY STITZEL, Research Assistant (until January 2001) CARRIE L. HOLLOWAY, Research Assistant GAIL E. SPEARS, Staff Editor SANDRA AMAMOO-KAKRA, Senior Project Assistant MICHELE RAMSEY, Senior Project Assistant (till June 2001) vii

SUBCOMMITTEE ON UPPER REFERENCE LEVELS OF NUTRIENTS IAN C. MUNRO (Chair via December 2001), CanTox, Inc., Mississauga, Ontario, Canada JOSEPH V. RODRICKS (Chair starting January 2002), ENVIRON International Corporation, Arlington, Virginia G. HARVEY ANDERSON, Department of Nutritional Sciences, University of Toronto, Ontario GEORGE C. BECKING, Phoenix OHC, Kingston, Ontario ELAINE FAUSTMAN, Department of Environmental Health, University of Washington, Seattle SUZANNE HENDRICH, Department of Food Science and Human Nutrition, Iowa State University, Ames SANFORD A. MILLER, Center for Food and Nutrition Policy, Virginia Polytechnic Institute and State University, Alexandria HARRIS PASTIDES, School of Public Health, University of South Carolina, Columbia JOHN A. THOMAS, San Antonio, Texas GARY M. WILLIAMS, Department of Environmental Pathology and Toxicology, New York Medical College, Valhalla, New York Staff SANDRA SCHLICKER, Study Director SANDRA AMAMOO-KAKRA, Senior Project Assistant viii

SUBCOMMITTEE ON INTERPRETATION AND USES OF DIETARY REFERENCE INTAKES SUSAN I. BARR (Chair), Department of Food, Nutrition, and Health, University of British Columbia, Vancouver TANYA D. AGURS-COLLINS, Department of Oncology, Howard University Cancer Center, Washington, D.C. ALICIA CARRIQUIRY, Department of Statistics, Iowa State University, Ames ANN M. COULSTON, Hattner/Coulston Nutrition Associates, LLC., Palo Alto, California BARBARA L. DEVANEY, Mathematica Policy Research, Princeton, New Jersey JANET HUNT, U.S. Department of Agriculture/Agriculture Research Service, Grand Forks Human Nutrition Research Center, Grand Forks, North Dakota SUZANNE MURPHY, Cancer Research Center of Hawaii, University of Hawaii, Honolulu VALERIE TARASUK, Department of Nutritional Sciences, University of Toronto, Ontario Staff MARY POOS, Study Director ALICE L. VOROSMARTI, Research Associate HARLEEN SETHI, Project Assistant ix

STANDING COMMITTEE ON THE SCIENTIFIC EVALUATION OF DIETARY REFERENCE INTAKES VERNON R. YOUNG (Chair via April 2002), Laboratory of Human Nutrition, School of Science, Massachusetts Institute of Technology, Cambridge JOHN W. ERDMAN, JR. (Vice-Chair), Department of Food Science and Human Nutrition, College of Agricultural, Consumer and Environmental Sciences, University of Illinois at Urbana-Champaign LINDSAY H. ALLEN, Department of Nutrition, University of California, Davis STEPHANIE A. ATKINSON, Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario JOHN D. FERNSTROM, UMPC Health System Weight Management Center, University of Pittsburgh School of Medicine, Pennsylvania SCOTT M. GRUNDY, Center for Human Nutrition, University of Texas Southwestern Medical Center at Dallas SANFORD A. MILLER, Center for Food and Nutrition Policy, Virginia Polytechnic Institute and State University, Alexandria WILLIAM M. RAND, Department of Family Medicine and Community Health, Tufts University School of Medicine, Boston, Massachusetts ROBERT M. RUSSELL, Jean Mayer U.S. Department of Agriculture Research Center on Aging, Tufts University, Boston, Massachusetts Technical Advisor to the DRI Projects GEORGE BEATON, GHB Consulting, Willowdale, Ontario U.S. Government Liaison KATHRYN Y. McMURRY, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Washington, D.C. Canadian Government Liaison PETER W.F. FISCHER, Nutrition Research Division, Health Protection Branch, Health Canada, Ottawa, Ontario x

Staff ALLISON A. YATES, Study Director MARY POOS, Senior Program Officer SANDRA SCHLICKER, Senior Program Officer PAULA R. TRUMBO, Senior Program Officer ALICE L. VOROSMARTI, Research Associate CARRIE L. HOLLOWAY, Research Assistant GAIL E. SPEARS, Staff Editor SANDRA AMAMOO-KAKRA, Senior Project Assistant xi

FOOD AND NUTRITION BOARD* CUTBERTO GARZA (Chair), Department of Nutrition Sciences, Cornell University, Ithaca, New York ROBERT M. RUSSELL (Vice-Chair), Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts VIRGINIA A. STALLINGS (Vice-Chair), Division of Gastroenterology and Nutrition, The Childrenâ€™s Hospital of Philadelphia, Pennsylvania LARRY R. BEUCHAT, Center for Food Safety and Quality Enhancement, University of Georgia, Griffin BENJAMIN CABALLERO, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland ROBERT J. COUSINS, Center for Nutritional Sciences, University of Florida, Gainesville SHIRIKI KUMANYIKA, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia LYNN PARKER, Child Nutrition Programs and Nutrition Policy, Food Research and Action Center, Washington, D.C. ROSS L. PRENTICE, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington A. CATHARINE ROSS, Department of Nutrition, Pennsylvania State University, University Park BARBARA O. SCHNEEMAN, Department of Nutrition, University of California, Davis ROBERT E. SMITH, R.E. Smith Consulting, Inc., Newport, Vermont STEVE L. TAYLOR, Department of Food Science and Technology and Food Processing Center, University of Nebraska, Lincoln CATHERINE E. WOTEKI, Iowa Agriculture and Human Economics Experiment Station, Iowa State University, Ames BARRY L. ZOUMAS, Department of Agricultural Economics and Rural Sociology, Pennsylvania State University, University Park Staff ALLISON A. YATES, Director LINDA MEYERS, Deputy Director GAIL E. SPEARS, Administrative Assistant GERALDINE KENNEDO, Administrative Assistant GARY WALKER, Financial Analyst *At time of unlock of prepublication replica. xii

Dedication The Panel on Macronutrients dedicates this report to the late Peter Reeds, a diligent and enthusiastic member of the panel who made important contributions to this learn about. His expertise in protein and amino acid metabolism used to be a unique asset to the panelâ€™s work, in addition to a contribution to the figuring out of protein and amino acid necessities. xiii

Preface This file is one in a sequence that items a comprehensive set of reference values for nutrient intakes for wholesome U.S. and Canadian indi- viduals and populations. It is a made from the Food and Nutrition Board of the Institute of Medicine (IOM), working in cooperation with Canadian scientists. The record establishes a collection of reference values for nutritional energy, carbohydrate, fiber, fat, fatty acids, ldl cholesterol, protein, and amino acids to amplify and substitute prior to now revealed Recommended Dietary Allow- ances (RDAs) and Recommended Nutrient Intakes (RNIs) for the United States and Canada, respectively. Close attention was given throughout the report back to the proof pertaining to macronutrient intakes to possibility aid of power illness and to amounts needed to handle health. Thus, the file includes tips for partitioning power resources (Acceptable Macronutrient Distribution Ranges) compatible with decreasing risks of various continual diseases. It additionally provides a definition for nutritional fiber. The teams responsible for growing this report, the Panel on Macronutrients, the Panel on the Definition of Dietary Fiber, the Sub- committee on Upper Reference Levels of Nutrients (UL Subcommittee), the Subcommittee on Interpretation and Uses of Dietary Reference Intakes (Uses Subcommittee), and the Standing Committee on the Scientific Evalua- tion of Dietary Reference Intakes (DRI Committee), have analyzed the evidence on risks and really helpful effects of vitamins and other meals com- ponents integrated in this overview. Although all reference values are in response to information, to be had data were steadily sparse or drawn from studies with significant obstacles in address- xv

xvi PREFACE ing more than a few questions confronted by way of the panel and subcommittees. Thus, although ruled via scientific rationales, informed judgments have been incessantly required in environment reference values. The reasoning used for every nutrient is described in Chapters 5 thru 11. Chapter Thirteen addresses major con- ceptual issues related to the uses of the DRIs that have been integrated in the early stages of the DRI procedure and feature been advanced additional by means of the Uses Subcommittee. The high quality and amount of data on overt deficiency sicknesses for protein, amino acids, and essential fatty acids to be had to the com- mittee had been really extensive. Unfortunately, information regarding different nutri- ents for which their number one dietary importance relates to their roles as power sources used to be limited maximum continuously to alterations in continual disease biomarkers that practice dietary manipulations of energy assets. Given the distinctiveness of the vitamins thought to be on this document (i.e., they or their precursors function power assets and, for this objective, can replace for each other in the diet), the lack of ability to resolve an Esti- mated Average Requirement (EAR) or a Tolerable Upper Intake Level (UL) in lots of circumstances is now not sudden. Also, for maximum of the nutrients in this report (with a notable exception of protein and some amino acids), there is no direct information that allows estimating the quantities required by children, adolescents, the elderly, or pregnant and lactating girls. Simi- larly, knowledge had been exceptionally sparse for environment ULs for the macronutrients. Doseâ€"reaction research have been either now not available or have been suggestive of very low consumption ranges that would lead to inadequate intakes of other vitamins. These knowledge gaps and inconsistencies frequently precluded setting reli- able estimates of upper consumption ranges that may be ingested safely. The reportâ€™s attention to power could be incomplete without its really extensive review of the role of day-to-day physical activity in achieving and sustaining fitness and optimum well being (Chapter 12). The record supplies really helpful ranges of energy expenditure which might be considered most com- patible with minimizing dangers of a number of persistent diseases and provides guid- ance for reaching recommended levels of energy expenditure. Inclusion of these suggestions avoids the tacit false assumption that gentle sedentary activity is the expected norm in the United States and Canada. Readers are advised to acknowledge that the Dietary Reference Intakes (DRI) procedure is iterative in persona. The Food and Nutrition Board and the DRI Committee and its subcommittees and panels totally expect that the DRI conceptual framework will evolve and be stepped forward as novel informa- tion turns into available and is carried out to an increasing list of nutrients and other meals parts. Thus, because the DRI activity is ongoing, com- ments had been solicited extensively and won on the published studies of this sequence. Refinements that resulted from this iterative procedure were incorporated in the normal information regarding approaches used (Chapters 1

xvii P REFACE via 4) and in the dialogue of makes use of of DRIs (Chapter 13). With more revel in, the proposed models for setting up reference intakes of vitamins and different food parts that play important roles in pro- moting and sustaining health and optimal functioning will probably be delicate. Also, as new knowledge or new methods of analysis are adopted, those reference values definitely will probably be reassessed. Many of the questions that have been raised about requirements and recommended intakes may now not be answered satisfactorily for the causes given above. Thus, amongst the panelâ€™s main tasks was to stipulate a research agenda addressing knowledge gaps exposed in its evaluation (Chapter 14). The research agenda is expected to help long term policy selections comparable to these and long term recommendations. This time table and the vital, com- prehensive analyses of to be had data are meant to assist the non-public sector, foundations, universities, governmental and global businesses and laboratories, and other establishments in the development of their respective research priorities for the subsequent decade. This report has been reviewed in draft form via individuals chosen for their diverse views and technical expertise, in accordance with pro- cedures approved by the NRCâ€™s Report Review Committee. The objective of this unbiased assessment is to supply candid and important feedback that will help the establishment in making its revealed record as sound as imaginable and to be sure that the file meets institutional requirements for objectivity, evidence, and responsiveness to the learn about rate. The overview comments and draft manuscript stay confidential to offer protection to the integrity of the deliberative process. We want to thank the following individuals for their evaluate of this file: Arne Astrup, The Royal Veterinary and Agricultural University; George Blackburn, Beth Israel Deaconess Medical Center; Elsworth Buskirk, Pennsylvania State University; William Connor, Oregon Health and Science University; John Hathcock, Council for Responsible Nutrition; Satish Kalhan, Case Western Reserve University School of Medicine; Martijn Katan, Wageningen Agricultural University; David Kritchevsky, The Wistar Institute; Shiriki Kumanyika, University of Pennsylvania School of Medicine; William Lands, National Institutes of Health; Geoffrey Livesey, Independent Nutrition Logic; Ross Prentice, Fred Hutchinson Cancer Research Center; Barbara Schneeman, University of California, Davis; Christopher Sempos, State University of New York, Buffalo; Virginia Stallings, Childrenâ€™s Hospital of Philadelphia; Steve Taylor, University of Nebraska; Daniel TomÃ©, Institut National Agronomique Paris-Grinon; and Walter Willett, Harvard School of Public Health.

xviii PREFACE Although the reviewers indexed above have equipped many positive comments and suggestions, they were not requested to endorse the conclu- sions or recommendations nor did they see the final draft of the file prior to its free up. The assessment of this file was once overseen through Catherine Ross, Pennsylvania State University and Irwin Rosenberg, Tufts University, appointed by the Institute of Medicine, who were accountable for making certain that an impartial examination of this report was carried out in accordance with institutional procedures and that all overview feedback were moderately regarded as. Responsibility for the final content material of this file rests entirely with the authoring committee and the institution. The Food and Nutrition Board gratefully recognizes the Canadian governmentâ€™s reinforce and Canadian scientistsâ€™ participation in this initia- tive. This shut collaboration represents a pioneering first step in the har- monization of nutrient reference intakes in North America. An outline of the general DRI challenge and of the panelâ€™s activity is given in Appendix B. The Food and Nutrition Board joins the DRI Committee, the Panel on Macronutrients, the Panel on the Definition of Dietary Fiber, the UL Sub- committee, and the Uses Subcommittee in extending trustworthy appreciation to the many experts who assisted with this report through giving shows to the quite a lot of teams charged with its development, providing written materials, participating in the groupsâ€™ open discussions, examining information, and other manner. Many, but some distance from all, of those people are named in Appendix C. Special gratitude is prolonged to the group of workers at ENVIRON Inter- nationwide Corporation for providing national survey information. The respective chairs and individuals of the Panel on Macronutrients and subcommittees carried out their paintings underneath nice time pressures. Their determination made the reportâ€™s well timed of completion conceivable. All gave their time and hard work willingly and without financial reward; the public and the science and observe of diet are amongst the primary beneficiaries in their determination. The Food and Nutrition Board thanks those indi- viduals, and especially the workforce responsible for its developmentâ€"in par- ticular, Paula Trumbo for coordinating this complicated record, and Sandra Schlicker, who served as a program officer for the learn about. The highbrow and managerial contributions made by those individuals to the reportâ€™s comprehensiveness and scientific base were vital to enjoyable the projectâ€™s mandate. Sincere thanks also pass to other FNB group of workers, together with Alice Vorosmarti, Kimberly Stitzel, Carrie Holloway, Gail Spears, Sandra Amamoo-Kakra, and Michele Ramsey, all of whom worked over nearly three years of work to finish this record. And last, however by no means least, the Food and Nutrition Board wishes to extend special thanks to Sandy Miller, who to begin with served as chair of the Panel on Macronutrients; Joanne Lupton, who due to this fact assumed the role of chair of the panel and endured in that role through the

xix P REFACE studyâ€™s crowning glory; and Vernon Young, who served as chair of the DRI Committee since the inception of the total DRI task. Professor Youngâ€™s willpower to this and earlier DRI activities and his uncompromis- ing standards for medical rigor are maximum gratefully acknowledged. Cutberto Garza Chair, Food and Nutrition Board

Contents SUMMARY 1 1 INTRODUCTION TO DIETARY REFERENCE INTAKES 21 What Are Dietary Reference Intakes? 21 Categories of Dietary Reference Intakes, 22 Determination of Adequacy, 28 Parameters for Dietary Reference Intakes, 29 Summary, 36 References, 36 2 METHODS AND APPROACHES USED 38 Overview, 38 Types of Data Used, 39 Methods to Determine the Adequate Intake for Infants, 44 Methods to Determine the Dietary Requirements for Children and Adults, 46 Estimates of Nutrient Intake, 48 Dietary Intakes in the United States and Canada, 49 Summary, 50 References, 50 3 RELATIONSHIP OF MACRONUTRIENTS AND PHYSICAL ACTIVITY TO CHRONIC DISEASE 53 Overview, 53 Cancer, 53 Heart Disease, 57 xxi

xxii CONTENTS Dental Caries, 61 Type 2 Diabetes Mellitus, 62 Obesity, 64 Skeletal Health, 66 Summary, 66 References, 66 4 A MODEL FOR THE DEVELOPMENT OF TOLERABLE UPPER INTAKE LEVELS 84 Background, 84 A Model for the Derivation of Tolerable Upper Intake Levels, 85 Risk Assessment and Food Safety, 86 Application of the Risk Assessment Model to Nutrients, 91 Steps in the Development of the Tolerable Upper Intake Level, 94 Intake Assessment, 104 Risk Characterization, 104 References, 105 5 ENERGY 107 Summary, 107 Background Information, 108 Selection of Indicators for Estimating the Requirement for Energy, 117 Factors Affecting Energy Expenditure and Requirements, 131 Approach Used to Determine Total Energy Expenditure, 151 Findings through Life Stage and Gender Group, 164 Adverse Effects of Overconsumption of Energy, 223 Research Recommendations, 225 References, 240 6 DIETARY CARBOHYDRATES: SUGARS AND STARCHES 265 Summary, 265 Background Information, 265 Evidence Considered for Estimating the Average Requirement for Carbohydrate, 277 Findings by way of Life Stage and Gender Group, 280 Intake of Carbohydrates, 294 Adverse Effects of Overconsumption, 295 Research Recommendations, 323 References, 324

xxiii C ONTENTS 7 DIETARY, FUNCTIONAL, AND TOTAL FIBER 339 Summary, 339 Background Information, 340 Evidence Considered for Estimating the Requirement for Dietary Fiber and Functional Fiber, 362 Findings through Life Stage and Gender Group, 384 Intake of Dietary Fiber, 390 Adverse Effects of Overconsumption, 391 Research Recommendations, 399 References, 400 8 DIETARY FATS: TOTAL FAT AND FATTY ACIDS 422 Summary, 422 Background Information, 424 Evidence Considered for Estimating the Requirements for Total Fat and Fatty Acids, 440 Factors Affecting the Requirements, 447 Findings by Life Stage and Gender Group, 456 Intakes of Total Fat and Fatty Acids, 473 Adverse Effects of Overconsumption, 481 Research Recommendations, 505 References, 515 9 CHOLESTEROL 542 Summary, 542 Background Information, 543 Findings via Life Stage and Gender Group, 546 Intake of Cholesterol, 549 Adverse Effects of Overconsumption, 549 Risk Characterization, 573 Research Recommendations, 574 References, 578 10 PROTEIN AND AMINO ACIDS 589 Summary, 589 Background Information, 590 Selection of Indicators for Estimating the Requirement for Protein (Nitrogen), 610 Selection of Indicators for Estimating the Requirement for Individual Amino Acids, 613 Findings by way of Life Stage and Gender Group for Total Protein, 619 Findings through Life Stage and Gender Group for Indispensable Amino Acids, 662

xxiv CONTENTS Intake of Total Protein and Amino Acids, 682 Tolerable Upper Intake Levels for Protein, 692 Tolerable Upper Intake Levels for Individual Amino Acids, 695 Research Recommendations, 737 References, 738 11 MACRONUTRIENTS AND HEALTHFUL DIETS 769 Summary, 769 Introduction, 770 Dietary Fat and Carbohydrate, 772 n-9 Monounsaturated Fatty Acids, 816 n-6 Polyunsaturated Fatty Acids, 820 n-3 Polyunsaturated Fatty Acids, 826 Saturated Fatty Acids, Trans Fatty Acids, and Cholesterol, 835 Conjugated Linoleic Acid, 836 Dietary Fiber and Functional Fiber, 838 Dietary Protein, 839 References, 845 12 PHYSICAL ACTIVITY 880 Summary, 880 Background Information, 881 Physical Activity Level and Energy Balance, 884 Evidence for Healthful Effects of Physical Activity, 912 Balance of Carbohydrate and Lipid Oxidation During Exercise and Recovery, 917 Physical Fitness, 923 Adverse Effects of Excessive Physical Activity, 926 Research Recommendations, 929 References, 929 13 APPLICATIONS OF DIETARY REFERENCE INTAKES FOR MACRONUTRIENTS 936 Overview, 936 Assessing Nutrient Intakes of Individuals, 937 Assessing Nutrient Intakes of Groups, 941 Planning Nutrient Intakes of Individuals, 946 Planning Nutrient Intakes of Groups, 947 Nutrient-Specific Considerations, 949 Integrated Example, 963 Summary, 964 References, 965

xxv C ONTENTS 14 A RESEARCH AGENDA 968 Approach, 968 Major Knowledge Gaps, 969 The Research Agenda, 971 APPENDIXES A Glossary and Acronyms 973 B Origin and Framework of the Development of Dietary Reference Intake 978 C Acknowledgments 985 D Dietary Intake Data from the Third National Health and Nutrition Examination Survey (NHANES III), 1988â€"1994 988 E Dietary Intake Data from the Continuing Survey of Food Intakes through Individuals (CSFII), 1994â€"1996, 1998 1028 F Canadian Dietary Intake Data, 1990â€"1997 1066 G Special Analyses for Dietary Fats 1076 H Body Composition Data Based on the Third National Health and Nutrition Examination Survey (NHANES III), 1988â€"1994 1078 I Doubly Labeled Water Data Used to Predict Energy Expenditure 1104 J Association of Added Sugars Intake and Intake of Other Nutrients, 1203 Ok Data Comparing Carbohydrate Intake to Intake of Other Nutrients from the Continuing Survey of Food Intakes via Individuals (CSFII), 1994â€"1996, 1998 1226 L Options for Dealing with Uncertainties 1244 M Nitrogen Balance Studies Used to Estimate the Protein Requirements in Adults 1250 BIOGRAPHICAL SKETCHES OF PANEL AND 1259 SUBCOMMITTEE MEMBERS 1275 INDEX 1319 SUMMARY TABLES, DIETARY REFERENCE INTAKES