Importance Of Customization Of Nutritional Supplement Based On Local RDA Guidelines

Consumption of nutrients within the standard limit is prerequisite for an individual as both over and undernutrition is associated with a variety of complications (1). Hence, dietary guidelines have been designed to guide people and to ensure nutritional adequacy (1).  This article reviews the role of local RDA guidelines and balanced nutrition in maintaining the overall health of an individual.

Nutrition requirements of an individual vary at every stage of life (2). Young children need more nutrients than those by adults (2). While in special physiological conditions such as pregnancy and lactation, women require extra nutrients to suffice the requirements for growth of the fetus in utero and during early post-natal life (2). Owing to the importance of dietary pattern in human life, Recommended Dietary Allowances (RDA) for essential nutrients have been established (3).

Concept of localized/national/regional dietary allowances

RDA, based on scientific knowledge, represents the level of essential nutrients to be consumed daily to meet the physiological needs of all healthy persons in a specified group (2). It is derived from the variability in nutrition requirement and bioavailability of nutrients from a given diet using different approaches such as repletion-depletion, factorial and nutrition balance (2,4). Nutrition requirements of an individual vary according to age, gender, and body weight (2). Anthropometric measurements such as body weight and height are determinants of nutrition, health status and growth rate of children whereas, in adults, they reflect potential features of normal growth (2). World Health Organization (WHO) has proposed internationally applicable anthropometric reference standards that form the basis while framing RDA for nutrients (2).

On the contrary, due to poverty and dietary constraints in developing countries, majority of the population fail to achieve anthropometric measurements corresponding to international reference standards (2). Therefore, each country must establish its own reference standards since the anthropometric measurements of its population may be genetically determined (2). These local reference standards should be set up based on the body weight and height of the individuals from a local elite population without any nutritional constraints (2).

Requirement of local RDA guidelines

Despite the presence of international guidelines and standards, there is a need for country-specific local RDA guidelines due to the following reasons (4):

  • Specific nutrition requirements due to variability in genetic and socio-demographic characteristics of the population (4).
  • Insufficient/ imbalanced intake of nutrients that leads to the malnutrition in the population of region (1).
  • Nature of the habitual diet and the dietary factors that affect the bioavailability of the nutrients (4). For example, >95% of Indian diet consists of non-heme food sources that leads to the low iron bioavailability as compared to western countries where >75% diet may be from heme source. Moreover, prevalence of iron-deficiency anemia is higher among Indian children and adolescence (2). Hence, for iron, higher RDA is required for Indian population and lower for western population (4).

Table 1: Difference in RDA for iron (mg/day) in countries (Adapted from ICMR 2011, NIH & Association of UK dietitians) (1,5,6).

India

US

UK

Group

RDA (mg/day)

Group

RDA (mg/day)

Group

RDA (mg/day)

Children
(4-6 y)

13

4–8 y

10

4-6 y

6.1

(7-9 y)

16

9–13 y

8

7-10 y

8.7

Adolescents (10-12 y)

21 (boy)
27 (girl)

14–18 years

11 (boy)
15 (girl)

11-18 y

11.3 (boy) 14.8 (girl)

(13-15 y)

32 (boy)
27 (girl)

(16-17 y)

28 (boy)
26 (girl)

Man

17

19–50 years

8

19–50 years

8.7

Woman

21

19-50 years

18

19-50 years

14.8

  • Region-specific dietary diversification and culinary practices (4), for example, cereal-pulse-vegetarian diet is a major source of protein (60%) for the Indian population. These proteins have low quality in terms of indispensable amino acids content and Protein digestibility corrected amino acid score (PDCASS) is less than 1 (7,8). Hence, Indians require a higher RDA for protein compared to western population (4).

Table 2: Difference in RDA for protein (g/day) in countries (Adapted from ICMR 2011, Dietary Reference Intakes 2002/2005) (1,9).

India

US

Group

RDA (g/day)

Group

RDA (g/day)

Children (4-6 y)

20.1

4–8 y

19

(7-9 y)

29.5

9–13 y

34

Adolescents
(10-12 y)

39.9 (boy),
40.4 (girl)

14–18 years

52 (boy),
46 (girl)

(13-15 y)

54.3 (boy),
51.9 (girl)

(16-17 y)

61.5 (boy),
55.5 (girl)

Man

60

19–70 years

56

Woman

55

19-70 years

46

  • Variability in deficiencies, lifestyle of the population, and prevalence of diseases in the area (4).
  • Food habits such as transition from traditional to modern food, excessive intake of processed and junk food, changing cooking practices also have altered the dietary behavior of the people in the country (1).
  • Overconsumption of the energy-dense foods due to its abundance and availability, and preferability among individuals may also increase the risk of malnutrition (1).

Though nutritional needs are similar in a broader sense, RDA should be decided based on the country-specific challenges to achieve the goal of good health among its individuals in the long-term without any side effects (4).

Role of balanced nutrition in maintaining the QOL

Dietary intakes above and below the body requirements can lead to overnutrition or undernutrition respectively (1). Long-term malnutrition is associated with chronic energy deficiency, iron deficiency anemia, iodine-related disorder, hypertension, diabetes, coronary heart disease, and cancer (1). Reportedly, these diseases affect the functional status and productivity that resulted in poor quality of life (QoL) of people (10). Hence, consumption of an adequate amount of nutrients may improve overall QoL via providing protection against chronic disorders (1, 11).

Children: In children, protein helps in catch up growth and development with the lean body mass (12).  Evidence suggests that dietary fiber helps to maintain the gastrointestinal function and prevents and treats constipation in children (13). Reportedly, the supplementation with 850 mg/day calcium has been shown to be linked with increased bone mineral density (14). Moreover, omega-3 docosahexaenoic acid (DHA) supplementation may improve cognitive behavior in children (15).

Adults: A multicenter trial conducted on 292 adults demonstrated that dietary instruction with a low-fat vegan diet had improved anxiety, depression, emotional well-being, daily functioning and productivity (16).

Pregnant and Lactating women: Women during pregnancy require an additional 350 calories and an appropriate amount of protein (0.5 g in 1st trimester, 6.9 g in 2nd trimester and 22.7 g in 3rd trimester) for proper nourishment of their child and for their own health (1).  Moreover, 1200 mg/d calcium, 35 mg/d iron and 0.5 mg/day folic acid etc. are essential for growth and development of offspring during pregnancy and lactation (1).

Older adults: In elderly population, higher protein intake improves muscles mass, strength and function (17). Reportedly, the supplementation with 400 IU vitamin D and 1000 mg/day calcium have been shown to be associated with a reduction in the incidence of hip fracture (18).

Owing to the food habits, lack of availability of nutrient-rich foods and many other factors, diet alone is not enough to meet the nutritional demands of an individual. Hence, supplementation is essential to fill this nutrients gap (1). However, nutrient-intake should be based on individual requirement and within the RDA set by the dietary guidelines (19). 

Conclusion

Adequate nutrition is essential to maintain good health from the time of conception to older age (1). However, requirements and intake of different nutrients vary among individuals (2). Hence, RDA has been established to address variable dietary needs of the population (2). Although dietary guidelines help to understand adequate nutritional intake, customization of diet is essential to meet an individual’s nutrient requirements (1, 2).

Reference

  1. Manual A. Dietary guidelines for Indians. Nat Inst Nutrition, Second edition. Hyderabad, India. 2011:89-117.
  2. Indian Council of Medical Research. Nutrient requirements and recommended dietary allowances for Indians. Indian Council of Medical Research; 2010: 1-334.
  3. Alasfoor D, Rajab H, Al-Rassasi B. Food based dietary guidelines, technical background and description. Muscat: Ministry of Health. 2007. http://www.fao.org/ag/humannutrition/19542-0561250979706400b7cc8ca7366cc07c0.pdf; Accessed date 06/03/2019.
  4. Nair KP, Augustine LF. Country-specific nutrient requirements & recommended dietary allowances for Indians: Current status & future directions. Indian Journal of Medical Research. 2018 May 1;148(5):522.
  5. National Institute of Health. Iron fact sheet for health professionals. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/access date: 15/03/2019.
  6. Food fact sheet. The Association of UK Dietitians. https://www.bda.uk.com/foodfacts/home/ access date 15/03/19.
  7. Swaminathan S, Vaz M, Kurpad AV. Protein intakes in India. British Journal of Nutrition. 2012 Aug;108(S2):S50-8.
  8. Kurpad AV, Minocha S. The health-nutrition-agriculture connect for protein in india. Bull Nutr Found India. 2017 Jan;38:8.
  9. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and AminoAcids(2002/2005) https://www.nal.usda.gov/sites/default/files/fnic_uploads/energy_full_report.pdf/accessdate:25/03/2019.
  10. Megari K. Quality of life in chronic disease patients. Health psychology research. 2013 Sep 24;1(3).
  11. Singh M. Role of micronutrients for physical growth and mental development. The Indian journal of pediatrics. 2004 Jan 1;71(1):59-62.
  12. Kanda A, Nakayama K, Sanbongi C, Nagata M, Ikegami S, Itoh H. Effects of whey, caseinate, or milk protein ingestion on muscle protein synthesis after exercise. Nutrients. 2016 Jun;8(6):339.
  13. Kranz S, Brauchla M, Slavin JL, Miller KB. What do we know about dietary fiber intake in children and health? The effects of fiber intake on constipation, obesity, and diabetes in children. Advances in nutrition. 2012 Jan 5;3(1):47-53.
  14. Chevalley T, Bonjour JP, Ferrari S, Hans D, Rizzoli R. Skeletal site selectivity in the effects of calcium supplementation on areal bone mineral density gain: a randomized, double-blind, placebo-controlled trial in prepubertal boys. The Journal of Clinical Endocrinology & Metabolism. 2005 Jun 1;90(6):3342-9.
  15. Richardson AJ, Burton JR, Sewell RP, Spreckelsen TF, Montgomery P. Docosahexaenoic acid for reading, cognition and behavior in children aged 7–9 years: a randomized, controlled trial (the DOLAB Study). PLoS one. 2012 Sep 6;7(9):e43909.
  16. Agarwal U, Mishra S, Xu J, Levin S, Gonzales J, Barnard ND. A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: the GEICO study. American Journal of Health Promotion. 2015 Mar;29(4):245-54.
  17. Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, Liu S, Looker AC, Wallace TC, Wang DD. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporosis International. 2016 Jan 1;27(1):367-76.
  18. Ahmed T, Haboubi N. Assessment and management of nutrition in older people and its importance to health. Clinical interventions in aging. 2010; 5:207.
  19. Kurpad A. Recommended dietary allowances-facts and uncertainties. Proceedings of the Indian National Science Academy. 2016 Dec 20;82(5):1555-63.

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