Chinese DRIs in Perspective of Global Disease Burden: Challenges, Evidence and Thinking_Chinese Journal of Evidence-Based Medicine

Authors：

CHEN Xiaofan ^1,2 ,  LI Youping ¹ , YU Jiajie ¹

1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;2. Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China;

Corresponding author：

LI Youping, Email: yzmylab@hotmail.com

Keywords：

Dietary reference intake (DRI); Recommended daily intake (RDA); Estimated average requirement (EAR); Recommend nutrients intake (RNI); Adequate intake (AI); Tolerable upper intake level (UL)

DOI：

10.7507/1672-2531.20130199

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To systematically review current status of Chinese DRIs, and compare the similarities and differences between Chinese and global DRIs, so as to provide references for regulating Chinese DRIs.
Methods 　Such database as PubMed, ISI Web of knowledge, The Cochrane Library, CBM, WanFang Data, CNKI and VIP were electronically searched from inception to May 31st, 2013. The reviewers independently screened studies according to inclusion and exclusion criteria, extracted data. Then, descriptive analysis was performed for basic information of literature, formulation of different DRIs, and DRIs distribution by different ages.
Results 　Initially, a total of 588 articles were retrieved, 42 of which were finally included, involving 14 guidelines, 12 systematic reviews (SRs), and 16 original studies. The results showed that, WHO guidelines and global systematic reviews focused on iron and fat-soluble vitamins (A and D); the original studies in China focused not only on iron and vitamin A but also on protein, calcium, zinc, and selenium. The included guidelines focused mainly on population aged 3-18 years old and pregnant women; and except for those two kinds of population, SRs also paid attention to adults aged more than 18 years. The original studies of Chinese DRIs were concerned about all kinds of population, mainly focused adults aged 18-45 years and school children aged 6-12 years. Among 16 included original studies, 4 were concerned about men and 2 about women.
Conclusion 　Chinese DRIs need urgent updates and supplement. As the largest developing country, China has different disease burdens, consumption levels, dietary patterns, nutrients’ content, and security levels, compared with developed countries and other developing countries. To develop evidence-based Chinese DRIs that are suitable for native health and Chinese local conditions, we should drawing lessons from the currently available best DRIs standards, methods and evidence based on Chinese actual conditions, disease burden, and expert opinion.

Citation： CHEN Xiaofan,LI Youping,YU Jiajie. Chinese DRIs in Perspective of Global Disease Burden: Challenges, Evidence and Thinking. Chinese Journal of Evidence-Based Medicine, 2013, 13(10): 1162-1171. doi: 10.7507/1672-2531.20130199 Copy

1.	Wang H, Dwyer-Lindgren L, Lofgren KT, et al. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2071-2094.
2.	Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2224-2260.
3.	中国营养学会. 中国居民膳食营养素参考摄入量. 中国轻工业出版社, 2000.
4.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Daily iron RN and folic acid supplementation in pregnant women. Geneva: World Health Organization, 2012.
5.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron and folic acid supplementation in non-anaemic pregnant women. Geneva: World Health Organization, 2012. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_intermittent_ifa_non_anaemic_pregnancy/en/.
6.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Sodium Intake for Adults and Children. Geneva: World Health Organization, 2012.
7.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Potassium Intake for Adults and Children. Geneva: World Health Organization, 2012.
8.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron supplementation in preschool and school-age children. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_iron_supplementation_children/en/.
9.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron and folic acid supplementation in menstruating women. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_iron_folicacid_suppl_women/en/.
10.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A supplementation during pregnancy for reducing the risk of mother-to-child transmission of HIV. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_mtct_hiv/en/.
11.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Neonatal vitamin A supplementation. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_neonatal/en/.
12.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A supplementation for infants and children 6-59 months of age. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_6to59_months/en/.
13.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A Supplementation in Infants 1–5 Months of Age. Geneva: World Health Organization, 2011.
14.	McGuire S. WHO Guideline: Vitamin A supplementation in pregnant women. Adv Nutr, 2012, 3(2): 215-216.
15.	McGuire S. WHO Guideline: Vitamin A supplementation in postpartum women. Adv Nutr, 2012, 3(2):215-216.
16.	WHO Guidelines Approved by the Guidelines Review Committee. FAO. Guidelines on food fortification with micronutrients. Geneva: WHO, 2006 [cited July 21, 2011]. Available from: http://www.who.int/nutrition/publications/ micronutrients/9241594012/en/index.html.
17.	Thiele DK, Senti JL, Anderson CM. Maternal vitamin D supplementation to meet the needs of the breastfed infant: a systematic review. J Hum Lact, 2013, 29(2): 1-8.
18.	Ngo J, Roman-Viñas B, Ribas-Barba L, et al. A systematic review on micronutrient intake adequacy in adult minority populations residing in Europe: the need for action. J Immigrant Minority Health, 2013, 3: 1-10.
19.	Rolland Y, de Souto Barreto P, Abellan Van Kan G, et al. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging, 2013, 17(4): 402-412.
20.	Aranceta J, Pérez-Rodrigo C. Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review. Br Nutr, 2012, 107: S8-s22.
21.	Steyn NP, Temple NJ. Evidence to support a food-based dietary guideline on sugar consumption in South Africa. BMC Public Health, 2012, 12: 502.
22.	Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2011, 96(7): 1911-1930.
23.	Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev, 2010, 68(8): 439-458.
24.	Torheim LE, Ferguson EL, Penrose K, et al. Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr, 2010, 140(11): 2051S-2058S.
25.	Hanley DA, Cranney A, Jones G, et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada. CMAJ, 2010, 182(12): E610-E618.
26.	Yetley EA, Brulé D, Cheney MC, et al. Dietary Reference Intakes for vitamin D: justification for a review of the 1997 values. Am J Clin Nutr, 2009, 89(3): 719-727.
27.	Tabacchi G, Wijnhoven TM, Branca F, et al. How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review. Br J Nutr, 2009, 101: S29-S36.
28.	Cranney A, Horsley T, O’Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep), 2007, (158): 1-235.
29.	咏梅, 舒畅, 宁鸿珍, 等. 学龄儿童锌、硒、铜、铁摄入水平对抗氧化能力的影响. 现代预防医学, 2011, 38(13): 2471-2473.
30.	弈明, KE Hill, 李平, 等. 中国成人硒需要量研究. 营养学报, 201, 33(2): 109-113.
31.	马冠生, 左娇蕾. 水的适宜摄入量. 中华预防医学杂志, 2011, 45(8): 675-678.
32.	唐咏梅, 朱骄峰, 周会, 等. 学龄儿童VA、VC、VE摄入水平对免疫功能影响. 中国公共卫生, 2010, 26(2): 208-210.
33.	郭长江, 韦京豫, 杨继军, 等. 我军重度劳动部队推荐的核黄素摄入量. 解放军预防医学杂志, 2010, 28(4): 238-241.
34.	周建烈, 毛绚霞, 顾景范. 维生素D膳食参考摄入量的再评估. 生理科学进展, 2009, 40(1): 36-40.
35.	何丽, 付萍, 张刚, 等. 不同钙摄入量对青年男性骨密度的影响. 中国健康教育, 2007, 23(6): 413-418.
36.	何丽, 付萍, 张坚, 等. 补钙对青年女性全身各部位骨密度的影响. 中国临床营养杂志, 2007, 15(3): 185-190.
37.	朴建华, 姬一兵, 田园, 等. 中国青年男性膳食蛋白质参考摄入量研究. Danone Institute China, 2008, 28-29.
38.	田颖. 中国青年女性膳食蛋白质参考摄入量研究. 博士论文, 2008: 298-299.
39.	尹婧, 张倩, 刘爱玲, 等.利用钙平衡法制定青春期少年钙参考摄入量的研究. 中国营养学会营养基金项目论文汇编, 2008: 33-40.
40.	陈祖培, 阎玉芹. 碘的膳食参考摄入量. 中华内分泌代谢杂志, 2005, 21(2): 188-192.
41.	贾青, 黄承钰, 周继昌. 藏族成年男子膳食中铁的吸收状况研究. 现代预防医学, 2005, 32(8): 872-874.
42.	贾青, 黄承钰, 周继昌. 藏族成年男子膳食中锌的吸收状况研究. 中国公共卫生, 2005, 21(8): 928-930.
43.	庞文贞, 许尔怡, 李守勤, 等. 学龄前儿童氮平衡测定及蛋白质适宜摄入量探讨. 营养学报, 1990, 12(4): 44-348.
44.	庞文贞, 黄思齐, 沈丽华, 等. 城市孕妇营养状况及孕妇热能、营养素适宜摄入量探讨. 营养学报, 1989, 11(3): 215-221.
45.	Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
46.	Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2163-2196.
47.	郭丽青. 饮食营养以及生活方式与慢性病控制. 第13届全国临床营养学术会议论文.
48.	罗卫平, 刘来新, 马江平, 等. 2010 年新疆监测点居民慢性病及其行为危险因素调查分析. 疾病预防控制通报, 2013, 28(1): 20-23.
49.	赵佳, 王建华, 叶薇薇, 等. 上海市杨浦区常住居民慢性病危险因素调查分析. 中国慢性病预防与控制, 2012, 20(1): 23-25.
50.	王劲, 郭红卫. 膳食营养素参考摄入量的制定原理和应用原则. 环境与职业医学, 2008, 25(5): 476-479.

1. Wang H, Dwyer-Lindgren L, Lofgren KT, et al. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2071-2094.
2. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2224-2260.
3. 中国营养学会. 中国居民膳食营养素参考摄入量. 中国轻工业出版社, 2000.
4. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Daily iron RN and folic acid supplementation in pregnant women. Geneva: World Health Organization, 2012.
5. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron and folic acid supplementation in non-anaemic pregnant women. Geneva: World Health Organization, 2012. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_intermittent_ifa_non_anaemic_pregnancy/en/.
6. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Sodium Intake for Adults and Children. Geneva: World Health Organization, 2012.
7. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Potassium Intake for Adults and Children. Geneva: World Health Organization, 2012.
8. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron supplementation in preschool and school-age children. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_iron_supplementation_children/en/.
9. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron and folic acid supplementation in menstruating women. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_iron_folicacid_suppl_women/en/.
10. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A supplementation during pregnancy for reducing the risk of mother-to-child transmission of HIV. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_mtct_hiv/en/.
11. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Neonatal vitamin A supplementation. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_neonatal/en/.
12. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A supplementation for infants and children 6-59 months of age. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_6to59_months/en/.
13. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A Supplementation in Infants 1–5 Months of Age. Geneva: World Health Organization, 2011.
14. McGuire S. WHO Guideline: Vitamin A supplementation in pregnant women. Adv Nutr, 2012, 3(2): 215-216.
15. McGuire S. WHO Guideline: Vitamin A supplementation in postpartum women. Adv Nutr, 2012, 3(2):215-216.
16. WHO Guidelines Approved by the Guidelines Review Committee. FAO. Guidelines on food fortification with micronutrients. Geneva: WHO, 2006 [cited July 21, 2011]. Available from: http://www.who.int/nutrition/publications/ micronutrients/9241594012/en/index.html.
17. Thiele DK, Senti JL, Anderson CM. Maternal vitamin D supplementation to meet the needs of the breastfed infant: a systematic review. J Hum Lact, 2013, 29(2): 1-8.
18. Ngo J, Roman-Viñas B, Ribas-Barba L, et al. A systematic review on micronutrient intake adequacy in adult minority populations residing in Europe: the need for action. J Immigrant Minority Health, 2013, 3: 1-10.
19. Rolland Y, de Souto Barreto P, Abellan Van Kan G, et al. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging, 2013, 17(4): 402-412.
20. Aranceta J, Pérez-Rodrigo C. Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review. Br Nutr, 2012, 107: S8-s22.
21. Steyn NP, Temple NJ. Evidence to support a food-based dietary guideline on sugar consumption in South Africa. BMC Public Health, 2012, 12: 502.
22. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2011, 96(7): 1911-1930.
23. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev, 2010, 68(8): 439-458.
24. Torheim LE, Ferguson EL, Penrose K, et al. Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr, 2010, 140(11): 2051S-2058S.
25. Hanley DA, Cranney A, Jones G, et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada. CMAJ, 2010, 182(12): E610-E618.
26. Yetley EA, Brulé D, Cheney MC, et al. Dietary Reference Intakes for vitamin D: justification for a review of the 1997 values. Am J Clin Nutr, 2009, 89(3): 719-727.
27. Tabacchi G, Wijnhoven TM, Branca F, et al. How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review. Br J Nutr, 2009, 101: S29-S36.
28. Cranney A, Horsley T, O’Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep), 2007, (158): 1-235.
29. 咏梅, 舒畅, 宁鸿珍, 等. 学龄儿童锌、硒、铜、铁摄入水平对抗氧化能力的影响. 现代预防医学, 2011, 38(13): 2471-2473.
30. 弈明, KE Hill, 李平, 等. 中国成人硒需要量研究. 营养学报, 201, 33(2): 109-113.
31. 马冠生, 左娇蕾. 水的适宜摄入量. 中华预防医学杂志, 2011, 45(8): 675-678.
32. 唐咏梅, 朱骄峰, 周会, 等. 学龄儿童VA、VC、VE摄入水平对免疫功能影响. 中国公共卫生, 2010, 26(2): 208-210.
33. 郭长江, 韦京豫, 杨继军, 等. 我军重度劳动部队推荐的核黄素摄入量. 解放军预防医学杂志, 2010, 28(4): 238-241.
34. 周建烈, 毛绚霞, 顾景范. 维生素D膳食参考摄入量的再评估. 生理科学进展, 2009, 40(1): 36-40.
35. 何丽, 付萍, 张刚, 等. 不同钙摄入量对青年男性骨密度的影响. 中国健康教育, 2007, 23(6): 413-418.
36. 何丽, 付萍, 张坚, 等. 补钙对青年女性全身各部位骨密度的影响. 中国临床营养杂志, 2007, 15(3): 185-190.
37. 朴建华, 姬一兵, 田园, 等. 中国青年男性膳食蛋白质参考摄入量研究. Danone Institute China, 2008, 28-29.
38. 田颖. 中国青年女性膳食蛋白质参考摄入量研究. 博士论文, 2008: 298-299.
39. 尹婧, 张倩, 刘爱玲, 等.利用钙平衡法制定青春期少年钙参考摄入量的研究. 中国营养学会营养基金项目论文汇编, 2008: 33-40.
40. 陈祖培, 阎玉芹. 碘的膳食参考摄入量. 中华内分泌代谢杂志, 2005, 21(2): 188-192.
41. 贾青, 黄承钰, 周继昌. 藏族成年男子膳食中铁的吸收状况研究. 现代预防医学, 2005, 32(8): 872-874.
42. 贾青, 黄承钰, 周继昌. 藏族成年男子膳食中锌的吸收状况研究. 中国公共卫生, 2005, 21(8): 928-930.
43. 庞文贞, 许尔怡, 李守勤, 等. 学龄前儿童氮平衡测定及蛋白质适宜摄入量探讨. 营养学报, 1990, 12(4): 44-348.
44. 庞文贞, 黄思齐, 沈丽华, 等. 城市孕妇营养状况及孕妇热能、营养素适宜摄入量探讨. 营养学报, 1989, 11(3): 215-221.
45. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
46. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2163-2196.
47. 郭丽青. 饮食营养以及生活方式与慢性病控制. 第13届全国临床营养学术会议论文.
48. 罗卫平, 刘来新, 马江平, 等. 2010 年新疆监测点居民慢性病及其行为危险因素调查分析. 疾病预防控制通报, 2013, 28(1): 20-23.
49. 赵佳, 王建华, 叶薇薇, 等. 上海市杨浦区常住居民慢性病危险因素调查分析. 中国慢性病预防与控制, 2012, 20(1): 23-25.
50. 王劲, 郭红卫. 膳食营养素参考摄入量的制定原理和应用原则. 环境与职业医学, 2008, 25(5): 476-479.

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Chinese DRIs in Perspective of Global Disease Burden: Challenges, Evidence and Thinking

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