The compilations of papers derived from the presentations at the 2nd Asian Network Symposium that are pub- lished concurrently in this issue offer an opportunity for the reader to gain a better understanding of the processes used for the development of country-specific nutrient reference intake recommendations and national dietary guidelines. This commentary offers a perspective of lessons learned from both the similarities and differences of approaches used among the Asian countries. Additionally, selected comparisons are made to actions and consid- erations related to nutrient requirements and national guidelines within the United States. It is hoped that contin- ued dialogue among different countries on these topics should further harmonization of nutritional recommenda- tions and provide an understanding for differences when they may occur.
The nutritional needs of Asian populations have changed dramatically in the last century. The role of nutrition, not only in preventing diseases associated with deficiency, but also in preventing lifestyle diseases such as car- diovascular disease and cancer, has become increasingly clear. Japan established the world’s first nutrition insti- tute almost 100 years ago, and initially focused on combating malnutrition and food insecurity. The current focus is prevention of lifestyle diseases, and along with revised dietary reference intakes, Japan has launched a program of Shokuiku (eating education) for children and families. As developing countries are simultaneously facing con- tinuing undernutrition and increasing obesity and lifestyle diseases, collaboration in research and programs is ur- gently needed to prevent disease through nutrition intervention. This symposium and the Asian network are ini- tial steps toward integrating nutriology into Asia-wide nutrition-based public health research and programs such as Japanese Shokuiku (eating education).
The Food and Nutrition Research Institute (FNRI) of the Department of Science and Technology (DOST), as in the past, led the review and revision of the 1989 Recommended Dietary Allowances (RDAs) for Filipinos, a vital and essential tool recognized in the nutrition and health community as the source of information on recommended energy and nutrient intakes for the maintenance of good health. This set of dietary standards is periodically evaluated and updated to keep pace with new knowledge on energy and nutrient requirements and metabolism. The set of updated standards is now called Recommended Energy and Nutrient Intakes (RENIs), defined as levels of intakes of energy and nutrients which, on the basis of current scientific knowledge, are considered adequate for the maintenance of good health and well-being of nearly all healthy Filipinos. As in the 1989 edition, intakes of energy, protein, calcium, phosphorus, iron, iodine, zinc, vitamins A, C, D and E, thiamin, riboflavin, niacin, folate, pyridoxine, water and electrolytes (sodium, potassium, chloride) are recommended in this new edition. The desirable proportions of protein, fats, carbohydrates as well as fiber are also provided, in addition to information on recommended intake levels for selenium, magnesium, manganese, fluoride, cobalamin, and vitamin K. These recommendations were derived from a review of current evidences, principally the UN-FAO/WHO’s 2002 hu- man vitamin and mineral requirements and the US-Institute of Medicine-Food and Nutrition Board (IOM-FNB)’s series of Dietary Reference Intakes, taking into consideration applicability in and achievability among specific population groups.
Issues and opportunities for RDA harmonization within the SEA region were first raised during the First Regional Forum and Workshop “RDAs: Scientific Basis and Future Directions”, held in Singapore in March 1997. A re- gional review on RDAs in SEA showed general similarities for the different RDAs, although in some cases a country listed an exceptionally high or low RDA for a particular nutrient for a specific group. It also revealed dif- ferences in physiologic groupings and reference body weights, nutrients included and units of expression. Realiz- ing these differences in RDA components between countries which makes technical composition different, a con- sensus on the need for regional collaboration and harmonization of RDAs was reached by participants from Indo- nesia, Malaysia, Philippines, Singapore, Thailand and Vietnam. A follow-up workshop was organized to work towards agreement throughout the region on common approaches, concepts and terminologies; application and uses, format and a research agenda. Round table discussions were held to arrive at specific recommendations for achieving harmonization. While divergence in opinions were expected, some clear-cut agreements were settled. Globalization envisions to achieve economic growth and development, with the effects expected to ripple through health, nutrition and welfare improvements. The harmonization of RDAs in SEA seeks to reach this vision by strengthening R and D capabilities (both logistic and manpower) within the region and within the countries in the region, as well as harmonizing the efforts of governments and industry within the region to reduce potential trade barriers such as those relating to food and nutrition quality assurance standards.
It has been well acknowledged that Vietnam is undergoing a nutrition transition. With a rapid change in the coun- try’s reform and economic growth, food supply at the macronutrient level has improved. Changes of the Viet- namese diet include significantly more foods of animal origin, and an increase of fat/oils, and ripe fruits. Conse- quently, nutritional problems in Vietnam now include not only malnutrition but also overweight/obesity, meta- bolic syndrome and other chronic diseases related to nutrition and lifestyles. The recognition of these shifts, which is also associated with morbidity and mortality, was a major factor in the need to review and update the Recommended Dietary Allowances (RDA) for the Vietnamese population. This revised RDA established an im- portant science-based tool for evaluation of nutrition adequacy, for teaching, and for scientific communications within Vietnam. It is expected that the 2007 Vietnam RDA and its conversion to food-based dietary guidelines will facilitate education to the public, as well as the policy implementation of programs for prevention of non- communicable chronic diseases and addressing the double burden of both under and over nutrition.
For more than 40 years, Recommended Dietary Allowances for Koreans (KRDA) were used as references for nu- trient intake. In 2002, the Korean Nutrition Society organized a committee to revise the KRDA, which were transformed into the new Dietary Reference Intakes for Koreans (KDRIs) in 2005. KDRIs include Estimated Av- erage Requirements (EAR), Recommended Intake (RI), Adequate Intake (AI) and Tolerable Upper Intake Level (UL) for protein, essential amino acids and micronutrients, Estimated Energy Requirement (EER) for energy and Acceptable Macronutrients Distribution Ranges (AMDR) for macronutrients. Evidence-based methods were used to determine the reference value (s) and the levels of nutrient intake for each nutrient. The KDRIs expanded sig- nificantly the number of nutrients and the basic concepts of nutrient recommendations compared to the previously used KRDA. In addition, a new food guide, depicted as Food Tower for Koreans, was developed and appended to the KDRIs publication. Continued efforts are needed to facilitate the application of KDRIs as well as to improve the understanding of the concepts. Additional modifications will be made as more scientific data become avail- able.
Following the comprehensive systematic review of domestic and overseas scientific evidence, the “Dietary Ref- erence Intakes for Japanese, 2005 (DRI-J)” was published in April, 2005. The DRIs-J were prepared for health individuals and groups and designed to present a reference for intake values of energy and 34 nutrients to main- tain and promote health and to prevent lifestyle-related diseases and illness due to excessive consumption of ei- ther energy or nutrients. The DRI-J also includes a special chapter for basic knowledge of DRIs. The energy rec- ommendation is provided as an estimated energy requirement (EER), while five indices were used for nutrients: Estimated average requirement (EAR), recommended dietary allowance (RDA), adequate intake (AI), tolerable upper intake level (UL), and tentative dietary goal for preventing lifestyle-related [chronic non-communicable] diseases (DG). Whilst the first four indices are same as the ones used in other countries, DG is unique index in Japan, which was set as a reference value for preventing non-communicable diseases such as cardiovascular (in- cluding hypertension), major types of cancer and osteoporosis. This report (DRI-J) is the first dietary guidance in Japan, which applied evidence-based approach utilizing a systematic review process. Only a few articles from within Japan and other Asian countries could be used for its establishment. The project to establish the DRI-J re- vealed a severe lack of researchers and publications focused upon establishing DRIs for Japanese. Further review is therefore required in preparation for the next revision scheduled in 2010.
This paper provides a review of the mid-term evaluation of “Health Japan 21” and discusses the status of progress towards the goals of items within the "Nutrition and diet" area. Among 14 items investi- gated, an improving trend was observed in eight items, though there was no improvement in five items. Whilst the percentage of obese individuals significantly increased during the 25 years from 1976 to 1999, secular trend showed that it has become unchanged since 2000, when “Health Japan 21” was enacted, regardless of gender and age. Another favorable finding was a decreasing trend of salt intake especially in the age group of 50-59 years. Besides, the analyses of the proportion of the persons “who have interest in dietary improvement” among the ones “who believe there are problems in their diet” showed that an increased awareness of inappropriate diet and also in the motivation to improve it, es- pecially among males aged 50-59 years. On the other hand, some items showed worsening trend; e.g. decrease in vegetable intake, decrease of persons who are aware of their own optimal weight and prac- tice weight control. Thus, the progress within Health Japan 21 was assessed as not necessarily satis- factory. In order to ensure the progress of “Health Japan 21” towards 2010, it is now crucial to effec- tively incorporate "Japanese Food Guide Spinning Top" and a new strategy of non-communicable dis- eases prevention focusing on the control of metabolic syndrome, which will be launched in April 2008, into the national health promotion program.