Dietary Reference Intakes for the Cuban Population , 2008

Recommended dietary reference intakes (DRI) for energy and nutrients for the Cuban population were first established by the Nutrition and Food Hygiene Institute (INHA, its Spanish acronym) in 1996.[1] International organizations and Cuban public health research subsequently generated a considerable volume of new information on food-based energy and nutrient requirements,[2-4] resulting in the need for a revision. Updated DRIs were therefore compiled by a multidisciplinary group of specialists and published in 2008 by INHA and the Cuban Ministry of Public Health.[5,6].

Recommended dietary reference intakes (DRI) for energy and nutrients for the Cuban population were first established by the Nutrition and Food Hygiene Institute (INHA, its Spanish acronym) in 1996.[1] International organizations and Cuban public health research subsequently generated a considerable volume of new information on food-based energy and nutrient requirements, [2][3][4] resulting in the need for a revision.Updated DRIs were therefore compiled by a multidisciplinary group of specialists and published in 2008 by INHA and the Cuban Ministry of Public Health.[5,6] The current recommendations establish adequate intakes for energy, protein, essential amino acids, fats, carbohydrates, dietary fiber, 14 vitamins, and 15 minerals or trace elements, as well as tolerable upper intake levels for some nutrients.To facilitate dietary planning, population-averaged dietary reference intakes are provided for the total Cuban population (2300 kcal, 69 g protein, 53 g fat, and 387 g carbohydrates) and by age group.Important changes include the use of body weight corresponding to a Body Mass Index (BMI) of 21 to establish the recommended energy intake for adults, and setting the recommended fat intake as 20% of total energy-quantities aimed at preventing overweight and the noncommunicable chronic diseases most prevalent in Cuba.
The dietary reference intake is the amount of a particular nutrient required to sustain normal metabolic, physical and psychic functioning; promote health and quality of life; prevent deficiency diseases and excess intake; and guarantee certain reserves for emergency situations.Recommended amounts are calculated to meet these needs in the majority of the population, taking into account diverse environmental conditions and life situations.Dietary recommendations are an important regulatory and educational tool for all sectors concerned with food and nutrition.They are fundamental to nutritional planning and to setting national policies aimed at safeguarding a healthy diet for the population.DRIs serve as targets in calculating availability of foodstuffsdomestically produced and imported-as well as in setting affordable pricing policies.Food and pharmaceutical industries use DRIs as guidelines for producing fortified foods and nutritional supplements for population groups with particular needs.They are also used as reference values for assessing food consumption surveys (at individual and macroeconomic levels) and for creating dietary guidelines.
The following is a summary version of the 2008 dietary recommendations for the Cuban population.[5] Energy and Macronutrients (Tables 1 and 2)

Proteins
Recommendations were based on the 2007 Joint WHO/FAO/ UNU Expert Consultation on Protein and Amino Acid Requirements in Human Nutrition, [21] which propose that protein constitute 10% of total energy intake in children aged <1 year and 12% of total energy intake for all other ages.For children aged <1 year, 70% of total protein should be of animal origin; for all other ages, the recommendation is 50%.The same FAO/WHO Requirements were also used to establish DRIs for Essential Amino Acids.

Fats
DRIs were established as a percentage of total energy intake: 40% for infants aged <6 months; 35% for children aged

Policy & Practice
isomer fatty acid intake be limited to 1% total energy, equivalent to 2 g/day in a 2000 kcal diet.[22] Carbohydrates DRIs have been established only recently.For the first time, a 130 g minimum carbohydrate intake was established for everyone except children aged <1 year, based on the brain's average glucose demand.
DRIs for carbohydrates are calculated as the percentage remaining once protein and fat portions of total energy intake has been established.Complex carbohydrates should make up 75% of the recommended carbohydrate intake and simple carbohydrates the remaining 25%.Sugar should not exceed 10% of total energy intake.

Dietary Fiber
For children aged >2 years, adequate intake values proposed by CJ Williams in 1995 were used, [23] calculated as age plus an additional 5 g/day (8 g/day for children aged 3 years up to 25 g/day at age 20 years).For adults aged 19-50, adequate intake is 25 g/day for women and 38 g/day for men, and for those aged >50 years, 21 g/day for women and 30 g/day for men.[4] The tolerable upper intake level is 55 g/day for adults and the sum of age plus 10 g/day for children.
Tolerable upper intake levels for Vitamin A (retinol only) are 600-900 μg for children aged ≤8 years, 1700 μg for those aged 9-13 years and 3000 μg for adults.Tolerable upper intake levels for pregnant women were set by INHA in 1998.[38] Vitamin D Recommendations were set at 5 μg colecalcipherol for children and adults aged 0-50 years, 10 μg for adults aged 50-65 years, and 15 μg for adults aged >65 years.Tolerable upper intake level is 25 μg for infants and 50 μg for children and adults.

Vitamin K
Research appears to indicate that 1 μg/kg/day intake is sufficient to maintain normal coagulation time in adults.DRIs were therefore set at 5-10 μg for children aged <1 year, 15-58 μg for children and adolescents, 55 μg for adult women, including those pregnant and lactating, and 65 μg for men.No tolerable upper intake level data is available for this vitamin.

Vitamin C
DRI is 25-30 mg for children aged <1 year and 30-40 mg for older children and adolescents.In order to enhance this nutrient's antioxidant action, 75 mg is recommended for women, 90 mg for men, 100 mg for pregnant women, and 120 mg for lactating women.An additional 35 mg is recommended for smokers, given the high oxidative stress associated with smoking.Tolerable upper intake levels are 400 mg for children aged <3 years, 650 mg for children aged ≤8 years, 1200 -1800 mg for children aged 9-18 years, and 2000 mg for adults.

Vitamin B Complex and Choline
The DRI for each B-complex component was established based on its general organic functions and on deficiency prevention.
• Folic acid The term "Dietary Folate Equivalent" (DFE) was adopted in response to the variable absorption of different folic acid compounds: 1 DFE = 1.0 μg folate content in food or 0.6 μg added to or taken with food, or 0.5 μg as a medical supplement taken on an empty stomach.Folic acid recommendations are 65-200 DFE for children aged ≤6 years, 300 DFE for children aged 7-13 years, 400 DFE for everyone aged ≥14 years, 500 DFE for lactating women, and 600 DFE for pregnant women as prevention against neural tube defects in newborns.The tolerable upper intake level was established as 800-1000 DFE.As it is difficult for pregnant and lactating women to obtain the high folic acid DRI levels from natural food, fortified foods or safe pharmacological supplements are recommended.

• Vitamin B1 (Thiamine)
The recommendation for this nutrient is closely related to energy and carbohydrate metabolism.Adequate nutritional status is provided by 0.5 mg/1000 kcal; for pregnant and lactating women, 0.6 mg/1000 kcal is recommended.For a wider safety margin, given the high sugar consumption in the Cuban population, the higher intakes proposed in 1996, based on higher recommended energy intakes, were maintained.Minimum recommended intake for adults is 1 mg if less than 1000 kcal are consumed.No tolerable upper intake level data is available.

Minerals and Trace Elements
DRIs were based on the 1996 Energy and Nutrient Recommendations for the Cuban Population; [1] on criteria established by the 2001 Joint FAO/WHO Expert Committee, [24] the Food and Nutrition Board of the US National Academy of Sciences, and other countries; and on results of recent INHA studies of the Cuban population's nutritional status for minerals and trace elements.[39][40][41][42][43][44][45] For sodium, chlorine and potassium, minimum requirements are proposed, since available elements are insufficient to establish recommended or adequate intake levels.
• Sodium The minimum sodium requirement ranges from 120 mg in the first months of life to 500 mg in adulthood and during pregnancy and lactation, and may be higher when there is profuse sweating or with certain illnesses.More than 2.3 g/ day sodium (5.8 g kitchen salt) is not recommended.Tolerable upper intake levels are 1.5-1.9g for children aged 1-8 years and 2.3 g for all other ages.• Chlorine Minimum requirements range from 180 mg in the first months of life to 750 mg for pregnant and lactating women.A 5 g/day intake of common salt provides 2100 mg of chlorine, almost three times the highest minimum requirement.• Potassium Minimum requirements range from 500 mg for infants to 2000 mg for adults.Adult tolerable upper intake level is 3500 mg/day.• Calcium Calcium deficiency, as well as the inefficient utilization of calcium by metabolism, is a current topic in nutrition research.Many dietary, hormonal and lifestyle factors influence the bioavailability of this nutrient; therefore, increasing recommended intake levels does not make sense without considering these other factors.Adequate intakes (AIs) have been proposed that can be attained practically: 300-600 mg for children aged <7 years; 800 mg for children aged ≥7 years and adults; and 1000 mg for pregnant and lactating women.Tolerable upper intake levels are 2500 mg/day for children aged >1 year and adults.• Phosphorus DRIs are determined by calcium AIs and were therefore set at 200-275 mg for children aged <1 year, 500-600 mg for children aged 1-7 years, 800 mg for children aged ≥7 years and adults, and 1000 mg for pregnant and lactating women.The calcium to phosphorus ratio is 1.5 for children aged <1 year and 1.0 for all other ages.Tolerable upper intake levels are 3000 mg for children aged 1-8 years and adults aged ≥70 years; 4000 mg for children and adults aged 9-69; 3500 mg for pregnant women and 4000 mg for lactating women.• Magnesium Given this mineral's importance, the DRIs established in 1996 are considered adequate and were maintained, ranging from 50-150 mg for children aged <2 years to 500 mg during pregnancy and lactation.Tolerable upper intake level is 65-110 mg for children and 350 mg for adults (only as chemically-synthesized supplements and not from food).

• Iron The most recent research on iron metabolism and
Cuba's nutritional status for iron were taken into account.DRI calculations assumed that Cubans consume a mixed diet with intermediate iron bioavailability.Recommended amounts were raised for children aged 6 months to 12 years, adults aged ≥18 years, and lactating women.Iron bioavailability is affected by many factors that should be considered when creating diets.For example, simultaneous intake of 25-100 mg of vitamin C can increase non-heminic iron absorption 2-4 times.
Given the high recommended iron intake for pregnant women (30 mg), foods fortified with this nutrient or pharmacological supplements are recommended.Tolerable upper intake levels are 40 mg for children and adolescents, and 45 mg for adults.Reference intakes for food energy corresponding to an "active" PAL were used for adult men, while intakes corresponding to a "low active" PAL was used for women.Height values of 1.72 m for men and 1.60 m for women, representing the 75th percentile in anthropometric charts of the Cuban population, were used.
[47] Additional requirements of pregnant and lactating women were estimated based on 115,000 pregnant women per year (considering the number of live births), a figure obtained from the Cuban Ministry of Health's 2007 Statistical Yearbook.[48] The following percentages of macronutrient contributions to total energy intake from food were used: Protein: 10% energy, children aged <1 year, 12% all other ages.Fat: 40% energy for infants aged <6 months, 35% for children aged 6 months to 2 years, 25% for children aged 2-6 years, 23% for children aged 7-13 years, and 20% for all other ages.Essential amino acids: 8% total energy.Carbohydrates: Calculated as the percentage remaining once protein and fat portions of total energy intake has been established.Complex carbohydrates should make up 75% of the recommended carbohydrate intake.
For dietary planning purposes, adding 20% to the 2300 kcal/ day averaged reference intake for the Cuban population is recommended.
Nutritional Supplements and Fortified Foods At present, no study has demonstrated that taking isolated chemicallysynthesized nutrients has the same beneficial effect as that associated with eating fruits, vegetables, whole grains, legumes and other natural food.These effects may be due to the combined, synergistic action of multiple components in food, many of which are as yet unidentified.This point of view is timely in an age when supplements and fortified foods in relatively concentrated form are heavily abused for the purpose of satisfying dietary reference intake amounts.Ideally, nutritional needs can be satisfied with food, although consideration can be made for some nutrients and vulnerable groups, such as iron and folic acid for pregnant women, whose high demands are not easily met with current diets.
diet: 60 mg tryptophan supplies an average of 1 mg niacin.The niacin equivalent (NE) is based on this ratio: 1 NE = 1 mg niacin = 60 mg dietary tryptophan.Niacin recommendations are based on caloric contribution.For children aged <6 months, 8 mg/100 kcal is recommended; for all other ages, 7 mg/1000 kcal.An additional 2 mg and 5 mg, are recommend-DRI is 1.1-2.4μgfor children and adults.Until more reliable data is available on requirements for older adults, pharmacological supplements or fortified foods are recommended.Vitamin B12 is only found in animal products, so strictly vegetarian diets can be lacking in this nutrient.In such cases, fortified foods or supplements are recommended.No tolerable upper intake level data is available.•Pantothenic acid No intake requirement has been established; DRI is based on observed intake sufficient to replace urinary excretion levels in healthy populations.Adequate intake 1.7-5.0mg, depending on age, 6.0 mg for pregnant women, and 7.0 mg for lactating women.No tolerable upper intake level data is available.• Biotine Adequate intake, based on observed intake in limited groups, ranges from 5 μg for infants to 30 μg for adults and pregnant women, and 35 μg for lactating women.No tolerable upper intake level data is available.• Choline Adequate intake is based primarily on levels necessary to maintain liver function and prevent memory disorders.
mg, respectively.As with thiamine, and for the same reason, the 1996 recommendations are maintained.Minimum recommended intake for adults is 1.2 mg.No tolerable upper intake level data is available.• Niacin Protein metabolism and niacin are closely related.A share of this nutrient's requirement is fulfilled by tryptophan in Policy & Practice the

Population-Averaged Dietary Refer- ence Intakes for Cuba (Table 3)
Manganese Since existing data is insufficient to establish DRIs, adequate intake amounts were proposed.Tolerable upper intake levels are 2-6 mg for children and 11 mg for adults.