Scanning for new evidence to prioritize updates to the Dietary Reference Intakes: case studies for thiamin and phosphorus

Am J Clin Nutr. 2016 Nov;104(5):1366-1377. doi: 10.3945/ajcn.115.128256. Epub 2016 Oct 12.

Abstract

Background: Dietary Reference Intakes (DRIs) are fundamental to inform national nutrition policy. However, a regular systematic review of the 51 nutrients that have DRIs has limited feasibility, and many DRIs have not been reviewed in >15 y.

Objective: To address this issue, individuals (nutrient review group) who were members of the Food and Nutrition Board developed a streamlined, evidence-based methodology that could be used to identify nutrients potentially in need of a systematic review.

Design: The proposed methodology, termed an evidence scan, comprises several steps. First, an analytic framework is developed to identify markers of associations between intake of a nutrient and a corresponding clinical outcome. Next, the framework is used to direct the identification of keywords for a scan of published research that is potentially relevant to intake requirements or upper intake levels for a nutrient. Last, a panel of content experts selects the abstracts that are likely to be relevant and reviews the full publications. The results may be used to determine whether a revision of the nutrient's DRI is an immediate priority but would not supplant a comprehensive systematic evidence review.

Results: To illustrate the process, 2 nutrients were selected as case studies: thiamin and phosphorus (DRIs were last set in 1998 and 1997, respectively). Using the evidence scan for thiamin, we identified 70 potentially relevant abstracts, of which 9 full publications were reviewed. For phosphorus, 127 potentially relevant abstracts were identified, and 29 full publications were reviewed.

Conclusions: From the review of these 2 nutrients, the nutrient review group concluded that there was insufficient new evidence to assign a high priority to a comprehensive systematic review for either thiamin or phosphorus. Evidence scanning is an efficient method of identifying DRI nutrients that are most in need of either a new or an updated systematic review.

Keywords: Dietary Reference Intakes; evidence scan; phosphorus; risk-assessment framework; thiamin.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Diet
  • Dose-Response Relationship, Drug
  • Evidence-Based Medicine
  • Humans
  • Nutrition Assessment
  • Nutrition Policy
  • Observational Studies as Topic
  • Phosphorus / administration & dosage*
  • Phosphorus / analysis
  • Pilot Projects
  • Randomized Controlled Trials as Topic
  • Recommended Dietary Allowances*
  • Risk Assessment
  • Thiamine / administration & dosage*
  • Thiamine / analysis

Substances

  • Phosphorus
  • Thiamine