ANNOTATED BIBLIOGRAPHY

Nutrition Requirements

©British Nutrition Foundation 2016

Who is responsible for setting nutrition requirements in the UK?

• In the UK we have a set of Dietary Reference Values (DRVs). • DRVs are a series of estimates of the energy and nutritional requirements of different groups

of healthy people in the UK population. They are not recommendations or goals for individuals.

• These were set by the Committee on Medical Aspects of Food and Nutrition Policy (COMA) in 1991.

• COMA used four types of Dietary Reference Values:

Estimated Average Requirements (EARs) The EAR is an estimate of the average requirement of energy or a nutrient needed by a group of people (i.e. approximately 50% of people will require less, and 50% will require more).

Reference Nutrient Intakes (RNIs) The RNI is the amount of a nutrient that is enough to ensure that the needs of nearly all a group (97.5%) are being met.

Lower Reference Nutrient Intakes (LRNIs) The LRNI is the amount of a nutrient that is enough for only a small number of people in a group who have low requirements (2.5%) i.e. the majority need more.

Safe Intake The Safe intake is used where there is insufficient evidence to set an EAR, RNI or LRNI. The safe intake is the amount judged to be enough for almost everyone, but below a level that could have undesirable effects.

• For most vitamins and minerals, DRVs are given as Reference Nutrient Intakes (RNI). Most

vitamins and minerals also have Lower Reference Nutrient Intakes.

• COMA has since been disbanded and replaced by the Scientific Advisory Committee on Nutrition (SACN) that advises the government on diet and health.

• SACN revised the population recommendations for estimated energy requirements in 2011 and in its report Carbohydrates and Health 2015 made new recommendations for free sugars and fibre.

• SACN made new recommendations for vitamin D in its report Vitamin D and Health 2016.

• The DRVs are reflected in the UK’s food based guidelines, the eatwell plate, a visual

illustration of the types and proportions of foods that contribute to a healthy and well- balanced diet.

Nutrition Requirements

©British Nutrition Foundation 2016

Macronutrients - Energy, fat, carbohydrates and protein

Estimated Average Requirements for Energy Infants

Age Males Females

Breastfed MJ kcal MJ kcal

1-2 months 2.2 526 2.0 478

3-4 months 2.4 574 2.2 526

5-6 months 2.5 598 2.3 550

7-12 months 2.9 694 2.7 646

Age Males Females

Formula-fed MJ kcal MJ kcal

1-2 months 2.5 598 2.3 550

3-4 months 2.6 622 2.5 598

5-6 months 2.7 646 2.6 622

7-12 months 3.1 742 2.8 670

Age Males Females

Mixed feeding or unknown

MJ kcal MJ kcal

1-2 months 2.4 574 2.1 502

3-4 months 2.5 598 2.3 550

5-6 months 2.6 622 2.4 574

7-12 months 3.0 718 2.7 646

1 year 3.2 765 3.0 717

2 years 4.2 1004 3.9 932

3 years 4.9 1171 4.5 1076

Nutrition Requirements

©British Nutrition Foundation 2016

Estimated Average Requirements for children

Males Females

Age (years) MJ/d kcal MJ/d kcal

4 5.8 1386 5.4 1291

5 6.2 1482 5.7 1362

6 6.6 1577 6.2 1482

7 6.9 1649 6.4 1530

8 7.3 1745 6.8 1625

9 7.7 1840 7.2 1721

10 8.5 2032 8.1 1936

11 8.9 2127 8.5 2032

12 9.4 2247 8.8 2103

13 10.1 2414 9.3 2223

14 11.0 2629 9.8 2342

15 11.8 2820 10.0 2390

16 12.4 2964 10.1 2414

17 12.9 3083 10.3 2462

18 13.2 3155 10.3 2462

Estimated Average Requirements for adults

Males Females

Age (years) MJ/d kcal MJ/d kcal

19-24 11.6 2772 9.1 2175

25-34 11.5 2749 9.1 2175

35-44 11.0 2629 8.8 2103

45-54 10.8 2581 8.8 2103

55-64 10.8 2581 8.7 2079

65-74 9.8 2342 7.7 1912

75+ 9.6 2294 8.7 1840

UK Energy requirements are based on the average energy required for people of a healthy weight who are

moderately active

 We can measure energy in calories (kcal) or in joules (MJ).

 Estimated energy requirements will be greater in more active people, and lower in those that are more sedentary. These will differ depending on size and gender.

 Energy requirements for pregnant women increase by 0.8 MJ/day or 200 kcal/day, but only in the final three months of pregnancy.

Nutrition Requirements

©British Nutrition Foundation 2016

Carbohydrate and Fat

 DRVs have been set for fat and carbohydrates (including sugars and dietary fibre) for the

population.

 DRVs for total fat, saturated fat, total carbohydrates and sugars are given as a percentage of

daily energy intake.

DRVs for carbohydrate and fat as a percentage of energy intake

% Daily Food Energy

Total Carbohydrate * 50%

of which free sugars * Not more than 5%

Total Fat ⱡ Not more than 35%

of which Saturated Fat ⱡ Not more than 11%

*based on SACN 2015 recommendations for population aged 2 years and above ⱡ based on COMA 1991 recommendations for population aged 5 years and above

 Total carbohydrate includes all starch, sugars and dietary fibre.

 Free sugars are sugars added to foods and drinks by the manufacturer, cook or consumer,

plus sugars naturally present in honey, syrups and fruit juice.

 Total fat includes all saturated and unsaturated fat (mono-and polyunsaturated).

 Saturated fat - Several studies have shown a high saturated fat intake to be linked with high blood cholesterol. Elevated blood cholesterol is a risk factor for coronary heart disease. Studies have shown that replacing saturated fat with unsaturated fat in the diet reduces blood cholesterol and lowers the risk of heart disease and stroke.

 On average in the UK we currently eat too much saturated fat and added sugar, but not enough fibre.

 Dietary Fibre – new recommendations were made by SACN in 2015 for the population aged 2 years and over:

Age group Recommended intake per day (g)

2-5 years 15

5-11 years 20

11-16 years 25

17 years and over 30

Salt

Age group Maximum salt intake per day (g)

0-6 months <1

6-12 months 1

1-3 years 2

4-6 years 3

7-10 years 5

11 years and above 6

Nutrition Requirements

©British Nutrition Foundation 2016

Protein

Reference Nutrient Intake for children

Age group RNI per day (g)

0-3 months 12.5

4-6 months 12.7

7-9 months 13.7

10-12 months 14.9

1-3 years 14.5

4-6 years 19.7

7-10 years 28.3

Adults

 The Reference Nutrient Intake (RNI) is set at 0.75 g of protein per kilogram bodyweight per day in adults.

For example:

• if an adult weighs 60 kg, they will need:

60 x 0.75 g/d = 45 g protein a day

• if an adult weighs 74 kg, they will need:

74 x 0.75 g/d = 55.5 g protein a day

 Protein requirements increase in pregnancy (an additional 6 g/d) and lactation (an additional

11 g/d 0-6 months and 8 g/d 6+ months)

The target salt intakes set for adults and children do not represent ideal or optimum consumption levels, but achievable population goals.

Nutrition Requirements

Sources: Department of Health, Dietary Reference Values for Food Energy and Nutrients for the United Kingdom, HMSO, 1991. SACN Vitamin D and Health, 2016.

Reference Nutrient Intakes for Vitamins

Age Thiamin Riboflavin Niacin Vitamin B6 Vitamin B12 Folate Vitamin C Vitamin A Vitamin D

mg/d mg/d mg/d mg/d † µg/d µg/d mg/d µg/d µg/d

0-3 months 0.2 0.4 3 0.2 0.3 50 25 350 8.5-10*** 4-6 months 0.2 0.4 3 0.2 0.3 50 25 350 8.5-10*** 7-9 months 0.2 0.4 4 0.3 0.4 50 25 350 8.5-10*** 10-12 months 0.3 0.4 5 0.4 0.4 50 25 350 8.5-10*** 1-3 years 0.5 0.6 8 0.7 0.5 70 30 400 10 4-6 years 0.7 0.8 11 0.9 0.8 100 30 400 10 7-10 years 0.7 1.0 12 1.0 1.0 150 30 500 10

Males

11-14 years 0.9 1.2 15 1.2 1.2 200 35 600 10 15-18 years 1.1 1.3 18 1.5 1.5 200 40 700 10 19-50 years 1.0 1.3 17 1.4 1.5 200 40 700 10 50+ years 0.9 1.3 16 1.4 1.5 200 40 700 10

Females

11-14 years 0.7 1.1 12 1.0 1.2 200 35 600 10 15-18 years 0.8 1.1 14 1.2 1.5 200 40 600 10 19-50 years 0.8 1.1 13 1.2 1.5 200 40 600 10 50+ years 0.8 1.1 12 1.2 1.5 200 40 600 10

Pregnancy + 0.1** + 0.3 * * * + 100 + 10** + 100 10

Lactation:

0-4 months + 0.2 + 0.5 + 2 * + 0.5 + 60 + 30 + 350 10 4+ months + 0.2 + 0.5 + 2 * + 0.5 + 60 + 30 + 350 10 † Based on protein providing 14.7% of EAR for energy *No increase **For last trimester only *** Safe intake. For more information on vitamin D recommendations,

visit our webpage https://www.nutrition.org.uk/healthyliving/basics/vitamind.html

Nutrition Requirements

Sources: Department of Health, Dietary Reference Values for Food Energy and Nutrients for the United Kingdom, HMSO, 1991. SACN Vitamin D and Health, 2016.

mg/d – milligram per day. A milligram is one thousandth of a gram µg/d – microgram per day. A microgram is a millionth of a gram 1 Phosphorous RNI is set equal to calcium in molar terms;

2 1mmol sodium = 23 mg;

3 1 mmol potassium= 39 mg;

4 Corresponds to sodium 1 mmol= 35.5 mg;

5 Insufficient for women with high menstrual losses where the most

practical way of meeting iron requirements is to take iron supplements

Reference Nutrient Intakes for Minerals

Age Calcium Phosphorus 1 Magnesium Sodium Potassium Chloride

4 Iron Zinc Copper Selenium Iodine

mg/d mg/d mg/d mg/d 2 mg/d

3 mg/d mg/d mg/d mg/d µg/d µg/d

0-3 months 525 400 55 210 800 320 1.7 4.0 0.2 10 50 4-6 months 525 400 60 280 850 400 4.3 4.0 0.3 13 60 7-9 months 525 400 75 320 700 500 7.8 5.0 0.3 10 60 10-12 months 525 400 80 350 700 500 7.8 5.0 0.3 10 60 1-3 years 350 270 85 500 800 800 6.9 5.0 0.4 15 70 4-6 years 450 350 120 700 1100 1100 6.1 6.5 0.6 20 100 7-10 years 550 450 200 1200 2000 1800 8.7 7.0 0.7 30 110 Males

11-14 years 1000 775 280 1600 3100 2500 11.3 9.0 0.8 45 130 15-18 years 1000 775 300 1600 3500 2500 11.3 9.5 1.0 70 140 19-50 years 700 550 300 1600 3500 2500 8.7 9.5 1.2 75 140 50+ years 700 550 300 1600 3500 2500 8.7 9.5 1.2 75 140

Females

11-14 years 800 625 280 1600 3100 2500 14.8 5 9.0 0.8 45 130

15-18 years 800 625 300 1600 3500 2500 14.8 5 7.0 1.0 60 140

19-50 years 700 550 270 1600 3500 2500 14.8 5 7.0 1.2 60 140

50+ years 700 550 270 1600 3500 2500 8.7 7.0 1.2 60 140

Pregnancy * * * * * * * * * * *

Lactation:

0-4 months + 550 + 440 + 50 * * * * + 6.0 + 0.3 + 15 * 4+ months + 550 + 440 + 50 * * * * + 2.5 + 0.3 + 15 *

Nutrition Requirements

©British Nutrition Foundation 2016

Factors affecting requirements

• Age e.g. the RNI for vitamin C for a child aged 1 year and under is 25 mg/d, and for an adult is 40 mg/d

• Gender e.g. the RNI for iron in women aged 19-50 years is 14.8 mg/d, which is higher than for men (8.7 mg/d) to cover menstrual losses

• Growth e.g. adolescents have higher calcium requirements to cover their bone growth

• Pregnancy and Lactation e.g. The RNI for calcium in women that are breastfeeding is 550 mg/d more than adult

females who are not breastfeeding.

Reference Intakes (RIs) for labelling

Helping the consumer make better choices for a healthier diet

• Reference Intakes (RIs) are used on nutrition labels on packaged food. • Reference intakes are set by European law, as a guide for the amount of energy and key

nutrients that can be eaten on a daily basis in order to maintain a healthy diet. • The values are maximum amounts based on an average female adult. They are not individual

recommendations and your needs may well be different to the RI, depending on your age, gender and how physically active you are.

• There are currently no RIs that can be used specifically for children. • Food labels show the percentage of the RIs that is provided per 100 g/100 ml and/or per

portion of the food item.

Energy or Nutrient Reference Intake

Energy 8400 kJ/2000 kcal

Fat 70 g

Saturates 20 g

Carbohydrate 260 g

Total sugars 90 g

Protein 50 g

Salt 6 g

To find out more information about food labels why not visit

http://www.nutrition.org.uk/healthyliving/healthyeating/labels.html

For more information on the sources used in this text, please contact [email protected]

Last reviewed Oct 2016. Next review due Oct 2019