Ann L. Yaktine

Dietary Reference Intakes for Calcium and Vitamin D

Calcium and vitamin D are two essential nutrients long known for their role in bone health. Over the last ten years, the public has heard conflicting messages about other benefits of these nutrients—especially vitamin D—and also about how much calcium and vitamin D they need to be healthy. To help clarify this issue, the U. S. and Canadian governments asked the Institute of Medicine (IOM) to assess the current data on health outcomes associated with calcium and vitamin D. The IOM tasked a committee of experts with reviewing the evidence, as well as updating the nutrient reference values, known as Dietary Reference Intakes (DRIs). These values are used widely by government agencies, for example, in setting standards for school meals or specifying the nutrition label on foods. Over time, they have come to be used by health professionals to counsel individuals about dietary intake. The committee provided an exhaustive review of studies on potential health outcomes and found that the evidence supported a role for these nutrients in bone health but not in other health conditions. Further, there is emerging evidence that too much of these nutrients may be harmful.

Child and Adult Care Food Program

Обов’язкова інформація для надання членам сімей та керівникам закладів денного догляду: • Лист членам сімей: Заклади денного догляду за дітьми, заклади рівня «Tier II» та заклади денного догляду за дорослими • Лист закладам рівня «Tier I» та закладам денного догляду сімейного типу • Форма відповідності доходів для отримання пільгового харчування: Заклади денного догляду за дітьми та Заклади денного догляду за дорослими (з інструкціями)

Aligning nutrition assistance programs with the Dietary Guidelines for Americans.

Nutrition assistance programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the National School Lunch and School Breakfast Programs (NSLP/SBP), and the Child and Adult Care Food Program (CACFP), are intended to offer low-income families the opportunity for a healthier food pattern that promotes overall health and reduces risk for chronic disease. To be successful in improving the diets of underserved Americans requires a unified approach toward meeting the nutritional needs of program participants. Newly revised recommendations increase intakes of fruits, vegetables, and whole-grain-rich foods while reducing consumption of saturated fats, added sugars, and sodium. In addition to improving the nutritional profile of meals and snacks for NSLP and CACFP and meal patterns for WIC, the new recommendations ensure variety within food groups for menus across a week and allow for regional and cultural preferences and increased flexibility of choice within food groups. The newly revised meal pattern recommendations are broadly applicable to the design of feeding programs for any age group and for any combination of meals and snacks being provided.

Nutrient and contaminant tradeoffs: exchanging meat, poultry, or seafood for dietary protein

When making food choices, consumers are faced with the dilemma of reconciling differences between health benefits and exposure to potential toxins. Analyses to estimate likely intake and exposure outcomes for young children and women of child-bearing age shows that seafood, chicken, and beef, while approximately equivalent in protein, vary in key nutrients of importance as well as in levels of certain contaminants. Increasing the variety of choices among meats, poultry, and seafood and consuming them in amounts consistent with current dietary guidelines and advisories will contribute toward meeting nutritional needs while reducing exposure to any single type of contaminant.

Sodium Intake in Populations

Despite efforts over the past several decades to reduce sodium intake in the United States, adults still consume an average of 3,400 mg of sodium every day. A number of scientific bodies and professional health organizations, including the American Heart Association, the American Medical Association, and the American Public Health Association, support reducing dietary sodium intake. These organizations support a common goal to reduce daily sodium intake to less than 2,300 milligrams and further reduce intake to 1,500 mg among persons who are 51 years of age and older and those of any age who are African-American or have hypertension, diabetes, or chronic kidney disease. A substantial body of evidence supports these efforts to reduce sodium intake. This evidence links excessive dietary sodium to high blood pressure, a surrogate marker for cardiovascular disease (CVD), stroke, and cardiac-related mortality. However, concerns have been raised that a low sodium intake may adversely affect certain risk factors, including blood lipids and insulin resistance, and thus potentially increase risk of heart disease and stroke. In fact, several recent reports have challenged sodium reduction in the population as a strategy to reduce this risk. Sodium Intake in Populations recognizes the limitations of the available evidence, and explains that there is no consistent evidence to support an association between sodium intake and either a beneficial or adverse effect on most direct health outcomes other than some CVD outcomes (including stroke and CVD mortality) and all-cause mortality. Some evidence suggested that decreasing sodium intake could possibly reduce the risk of gastric cancer. However, the evidence was too limited to conclude the converse-that higher sodium intake could possibly increase the risk of gastric cancer. Interpreting these findings was particularly challenging because most studies were conducted outside the United States in populations consuming much higher levels of sodium than those consumed in this country. Sodium Intake in Populations is a summary of the findings and conclusions on evidence for associations between sodium intake and risk of CVD-related events and mortality.

I. INTRODUCTION AND CONCEPTUAL FRAMEWORK

Children with incarcerated parents are at risk for a variety of problematic outcomes, yet research has rarely examined protective factors or resilience processes that might mitigate such risk in this population. In this volume, we present findings from five new studies that focus on child- or family-level resilience processes in children with parents currently or recently incarcerated in jail or prison. In the first study, empathic responding is examined as a protective factor against aggressive peer relations for 210 elementary school age children of incarcerated parents. The second study further examines socially aggressive behaviors with peers, with a focus on teasing and bullying, in a sample of 61 children of incarcerated mothers. Emotion regulation is examined as a possible protective factor. The third study contrasts childrens placement with maternal grandmothers versus other caregivers in a sample of 138 mothers incarcerated in a medium security state prison. The relation between a history of positive attachments between mothers and grandmothers and the current cocaregiving alliance are of particular interest. The fourth study examines coparenting communication in depth on the basis of observations of 13 families with young children whose mothers were recently released from jail. Finally, in the fifth study, the proximal impacts of a parent management training intervention on individual functioning and family relationships are investigated in a diverse sample of 359 imprisoned mothers and fathers. Taken together, these studies further our understanding of resilience processes in children of incarcerated parents and their families and set the groundwork for further research on child development and family resilience within the context of parental involvement in the criminal justice system.

Food and Nutrition Board Update: What Do SNAP Allotments, Physical Fitness, and Obesity Prevention Have in Common?

The Institute of Medicines Food and Nutrition Board had a productive year, with important expert committee reports on the Supplemental Food Assistance Program, physical fitness, and accelerating obesity prevention efforts that provided grounding for dietary guidance and nutrition policies and programs. This summary describes Food and Nutrition Board activities, including current thinking on dietary reference intakes. The summary also highlights consensus reports on defining and measuring Supplemental Food Assistance Program benefit adequacy and on physical fitness and health outcomes in youth. In addition, current and new activities related to obesity prevention and care are addressed. What do these activities have in common? All adhere to the Institute of Medicine report model by filling gaps and by being analytical, evidence-based, and challenging.