LARN, EFSA updates dietary reference values

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On 9/18/19, theEuropean Food Safety Authority (EFSA) published the updated list of dietary reference values. As a result of decades of research on average daily requirements of nutrients and micronutrients, known as DRVs(Dietary Reference Values), in Italy as LARNs (Reference Intake Levels of Nutrients and Energy). The problem of excess sodium/salt in the European population is back in the limelight.

LARN, the daily dietary requirements.

Reference Intake Levels of Nutrients and Energy (RLAs ) have been developed over the decades by scientific institutions dedicated to human nutrition. Such as the Italian Society of Human Nutrition (SINU), which in 2014 published the 4th edition of its recommendations on the dietary needs of the Italian population. Tables are prepared and updated periodically, based on monitoring, scientific and epidemiological studies. Aiming to identify and publicize the average values of nutrients–e.g., protein, carbohydrates, fat, fiber–and micronutrients (e.g., vitamins, minerals) needed for proper functioning of the body. Values refer to the healthy population, separated by sex and age groups. (1)

Nutritional standards were first published in the US, in 1941, in the form of ‘Recommended Dietary Allowances‘ (RDAs). Just to ensure the supply, to American citizens, of essential amounts of protein, energy, iron and calcium, and some vitamins. (2) For the purpose of preventing diseases that may result from malnutrition, understood in qualitative as well as quantitative terms. Not only in Low-Middle Income Countries (LMICs), but also in the U.S. and Europe, and where inequality causes, among other things, hunger and housing emergency.

The LARNs-or DRVs(Dietary Reference Values)-are then used to organize public provision of meals (school and hospital pavilions, offices), plan social policies (where they exist), training of medical and school personnel, public education programs. In relation to these objectives, the tables show the following data:

– Average Requirements(AR), which is the minimum intake sufficient to cover the needs of the majority (50%) of healthy individuals,

Population Reference Intakes (PRI), the level of intake sufficient for the entirety (97.5 percent) of the healthy population,

– Adequate Intake(AI), a value assumed to be adequate to meet the needs of the population when it is impossible to define AR and PRI,

Reference Intakes (RI), i.e., the average levels of macronutrients that allow adequate intake, (3)

– tolerableupper intake level (UL), above which the intake of a nutrient could increase the risk of disease or adverse effects,

– Suggesteddietary target (SDT) for prevention.

LARN – DRVs, the work of EFSA.

On 4.9.19, the European Food Safety Authority published its two latest scientific opinions on dietary reference values for sodium and chloride. (4) This completes the update of previous European work in this area, which dated back to the early 1990s. With 32 EFSA scientific opinions published in the past 7 years on LARNs for 34 nutrients. Water, protein, carbohydrates and dietary fiber, fat, energy, 14 vitamins and 13 minerals.

Reference values should not be understood as nutritional goals aimed at individuals, as they vary by gender, life stages, and exercise levels. Insufficient or excessive intake of nutrients through the diet, moreover, is associated with an increased risk of disease. And while in the beginning these tables assumed public health goals related to undernutrition, in recent decades research has instead focused on the risks associated with excess.

The exponential and endemic growth of chronicNon-Communicable Diseases (NCDs)-such as obesity, type 2 diabetes, cardiovascular and metabolic diseases, hepatic steatosis, cancers, etc. – has therefore prompted EFSA experts to consider new priorities. Therefore, examining new data, such as those from large-scale cohort studies, to assess correlations between nutrient intakes and disease risk.

EFSA’s publication of DRVs-easily accessible, on the dedicated web page(LARN Finder)-is therefore useful:

– consumers as an aid to composing balanced diets,

– to nutrition and health professionals to assess nutritional needs and develop diets,

– to food manufacturers, to formulate and especially reformulate products (c.d.
food product improvement
)

– to risk managers to take the necessary measures to counter obesity, overweight and related diseases (NCDs). As well as establishing the fateful nutrient profiles, after nearly 11 years of unacceptable delay by the European Commission.

LARN, the sodium/salt point

Sodium and chloride-which in Western diets are mainly found in salt, in addition to being naturally present in most foods-were the subject of the last two scientific opinions of the EFSA NDA(Nutrition, Novel Foods and Food Allergens) panel. (4) The body needs them to function, but their excessive intake-which is unfortunately the rule, even in Europe-is an inexorable cause of increased blood pressure, a primary risk factor for cardiovascular disease, and other serious illnesses. (5)

Following reviews of scientific literature, EFSA experts came to define 2 g of sodium (equal to 5 g of salt, or sodium chloride) per day as the safe threshold for the adult population. Moreover, in line with the recommendations already expressed by the World Health Organization (WHO). Managers of public health risks related to nutritional safety-i.e., the European Commission and member state health administrations-will be able to refer to this threshold to set the necessary targets for reducing its intake by the population. As was done in 2014, to no avail, by the United Kingdom.

Dario Dongo

Notes

(1) Instead, the dietary needs of sick people must be considered on a case-by-case basis. Taking into account the energy consumed and any additional requirements related to individual diseases or treatments

(2) In memory of long-standing concerns about possible nutritional deficiencies, some U.S. states still mandate mandatory ‘fortification’ of all grain products (e.g., flour, pasta, bread) with vitamins and minerals

(3) Also relevant to voluntary nutrition labeling on the front of the package. See previous article

(4) EFSA, NDA(Nutrition, Novel Foods and Food Allergens) Panel (2019).

Dietary reference values for sodium, https://doi.org/10.2903/sp.efsa.2019.EN-1679

Dietary reference values for chloride, https://doi.org/10.2903/j.efsa.2019.5779

(5) Consumers themselves value salt reductions in packaged foods, according to the scientific study published back in 2016 in the American Journal of Clinical Nutrition. V. https://www.greatitalianfoodtrade.it/salute/il-sale-nuoce

Excess sodium/salt is indeed considered a cause of serious noncommunicable diseases (NCDs). Cardiovascular diseases, heart attacks and cancers, diabetes