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European Journal of Clinical Nutrition (2004) 58, 191–194
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New dietary reference intakes in the Netherlands for
energy, proteins, fats and digestible carbohydrates
CJK Spaaij1* and LTJ Pijls1
1
Health Council of the Netherlands, The Hague, The Netherlands
European Journal of Clinical Nutrition (2004) 58, 191–194. doi:10.1038/sj.ejcn.1601788
The Health Council of the Netherlands published new
Dutch dietary reference intakes (DRIs) for energy, proteins,
fats and digestible carbohydrates (Table 1; Health Council
of the Netherlands, 2001). The previous Dutch values
were primarily aimed at the prevention of deficiency
symptoms, whereas the current Dutch values aim at
the prevention of both deficiency and chronic diseases.
Values were specified for infants, young children,
adolescents, adults, elderly people and for pregnant
and lactating women. The age groups are similar to
those used in the United States (Institute of Medicine,
2002). The report provides a comparison of the new
Dutch dietary reference intakes with previous Dutch
values and with the values used in Scandinavia, Germany,
Switzerland, Austria, Great Britain and the European
Community. At that time, the new American DRIs for
energy and macronutrients were not yet available.
Therefore, we now present a comparison with the new
American values (Institute of Medicine, 2002). The full
report can be read and downloaded from internet site
www.gr.nl.
Terminology and definitions
The term ’dietary reference intakes’ is a collective term for
the ‘estimated average requirement’, ‘recommended dietary
allowance’, ‘adequate intake’ and ‘tolerable upper intake
level’. Both the recommended dietary allowance and the
adequate intake reflect the intake level at which no signs of
deficiency are observed, and at which the risk of chronic
diseases, as far as influenced by the nutrient, is kept as small
*Correspondence: CJK Spaaij, Health Council of the Netherlands, PO Box
16052, 2500 BB The Hague, The Netherlands.
E-mail: [email protected]
Contributors: CJKS and LTJP.
Received 4 November 2002; revised 3 April 2003; accepted 17 April 2003
as possible. Given a requirement with a normal distribution,
the estimated average requirement is the level of intake
that is adequate for half of the population. The tolerable
upper intake level is the level of intake above which there
is a chance that adverse effects will occur. The definitions
of the DRIs are similar to those in the new American reports
on dietary reference intakes. In the American report
on energy and macronutrients, apart from these DRIs,
acceptable macronutrient distribution ranges have been
estimated.
Energy
The Dutch report presents estimated average requirements
for energy, with the remark that for the prevention of
undesirable weight gains, everyone’s energy intake should
conform to their personal requirement rather than to this
estimated average requirement. Therefore, the report also
contains formulae with which individuals can estimate their
personal energy requirement on the basis of age, body
weight and level of physical activity.
The estimated average requirements for children were
based on the energy needs for growth and on the daily
energy expenditure. Results of measurements with
the doubly labelled water method were used to estimate
the average daily energy expenditure of children. For
adults, a meta-analysis of data obtained with the doubly
labelled water method was used to describe the influence
of physical activity on energy needs. The estimated average
requirement was then calculated by multiplying the
estimated average basal metabolic rate of reference
men and women by the average physical activity level in
the Netherlands. Reference adults were defined as men
and women of average body height with an optimal body
mass index. For the age groups between 18 and 50 y, 22.5 kg/
m2Fthe average of 20 and 25 kg/m2Fwas taken as the
Dietary reference intakes in the Netherlands
CJK Spaaij and LTJ Pijls
192
Table 1 Dietary reference intakes for the age group 31–50 yearsa
Nutrientb
Unit
Energy
MJ/day
Proteins
g/day
Energy%
Fats
Energy%
Linoleic acid
a-Linolenic acid
n-3 Fatty acids from fish
PUFA
Energy%
Energy%
g/day
Energy%
MUFA+PUFA
Energy%
SFA
Trans fatty acids
Digestible carbohydrates
Energy%
Energy%
g/day
Energy%
Subgroupc
Dietary reference intakesd,e
EAR
RDA
AI
UL
Men
Women
Men
Women
Men
Women
People with optimal body weight
Overweight people or people with undesirable weight gain
F
F
F
F
12.2
9.7
45f
39f
F
F
F
F
F
F
F
F
F
F
59f
50f
8f,g
9f,g
F
F
F
F
F
F
F
F
F
F
F
F
20–40
20–30/35
2
1
0.2
F
F
F
F
F
25
25
F
F
F
F
F
12
people with optimal body weight
overweight people or people with undesirable weight gain
F
F
F
F
F
F
F
F
194
F
F
F
F
F
272
40g
8–38h
8–28/33h
As low as possible
As low as possible
F
F
F
F
10
1
F
F
a
Values for other age groups and for women during pregnancy and lactation can be found in the full report, see www.gr.nl.
PUFA=polyunsaturated fatty acids; MUFA = monounsaturated fatty acids; SFA = saturated fatty acids.
c
’–’ = no subgroups.
d
EAR=estimated average requirement; RDA=recommended dietary allowance; AI=adequate intake; UL=tolerable upper intake level.
e
’–’=no value set.
f
Values presented are meant for people with a mixed diet; for lacto-ovo vegetarians and vegans they should be multiplied with respectively 1.2 and 1.3.
g
Based on the RDA in g/day and the EAR for energy.
h
Based on the AI for fats and the ULs for saturated fatty acids and trans fatty acids.
b
optimal value for the body mass index; for those aged
51–70 y this was 24 kg/m2 and for people older than 70 y
25 kg/m2.
For adults with the characteristics of the Dutch reference
men and women, the new American estimated energy
requirements are very close to the Dutch estimated average
requirements.
show greater conformity with those in other countries,
including the USA.
The new Dutch tolerable upper intake level for proteins is
25% for all groups aged 4 y or more. For the first 6 months of
life, the tolerable upper intake level was set at 10% of the
energy intake; for 6 months to 1 y at 15 energy % and for the
age group from 1 to 3 y at 20 energy %.
Protein
Fat
The estimated average requirements for proteins are
based on the nitrogen losses with urine, faeces, hair, nails
and sweat, the nitrogen requirements for growth,
the nitrogen content of body proteins, the efficiency with
which body protein is synthesized from amino-acids,
and the digestibility and amino-acid composition of dietary
proteins. The recommended dietary allowances for healthy
adults with a mixed diet are 8–11% of the energy
intake, depending on age group and sex. The values for
individuals with a lacto-ovo vegetarian dietary pattern and
a vegan dietary pattern are respectively 1.2 and 1.3 times
higher, as a result of the different amino-acid composition
of the dietary proteins. The new recommended dietary
allowances are lower than the previous Dutch values, but
With regard to the total consumption of fat, the Health
Council of the Netherlands distinguishes people with an
optimum weight from those who are overweight or who
have undesirable weight gains. This is a new element,
relative to foreign dietary reference intakes and to previous
Dutch dietary reference intakes. For individuals with an
optimal and constant body weight, any level of fat intake
between 20 and 40% of total energy intake is considered
adequate. For individuals who are overweight or who have
undesirable weight gains, the range of adequate intake levels
for fats has the same lower limit (20% of total energy intake),
but a lower upper limit (30–35% of total energy intake). The
reason for this distinction is the finding that a low-fat diet
can lead to a reduction of body weight or can combat the
European Journal of Clinical Nutrition
Dietary reference intakes in the Netherlands
CJK Spaaij and LTJ Pijls
193
weight gain with increasing age. Energy, rather than fat, is
the deciding factor: even low-fat diets result in weight gain if
energy intake is excessive. However, individuals on a high-fat
diet are more likely to consume excessive amounts of energy.
The effect on body weight is quite modest. A reduction of the
fat content of the diet from 40 to 30% of energy intake was
estimated to reduce body weight with 2–3 kg. However,
according to the Health Council of the Netherlands, even
such slight effect on body weight can contribute to the
prevention of diabetes mellitus type II and (to a lesser extent)
coronary artery disease.
The new American acceptable macronutrient distribution
range for fat is similar to the Dutch adequate intake for
people who are overweight or who have undesirable weight
gains: 20–35% of energy.
adverse effect. The adequate intake for a-linolenic acid,
1% of energy intake, is based on the beneficial effect on
the risk of coronary artery disease. In the American report
the acceptable macronutrient distribution range for
a-linolenic acid is set at 0.6–1.2% of energy. As for
linoleic acid, the lower boundary level is based on the
median intake in the United States and corresponds to
the new American adequate intake, formulated in grams
per day.
Based on the beneficial effect on the risk of coronary artery
disease, the Health Council of the Netherlands sets the
adequate intake for n-3 fatty acids from fish at 0.2 g/day. The
American committee states that up to 10% of the acceptable
macronutrient distribution range for a-linolenic acid may be
consumed as n-3 fatty acids from fish.
Digestible carbohydrates
Fatty acids
In addition to the dietary reference intakes for total fat
consumption, the Dutch report focuses to a large extent on
the composition of dietary fat. Distinguished are saturated
fatty acids, trans fatty acids, monounsaturated fatty acids and
(some) polyunsaturated fatty acids.
The Health Council of the Netherlands states that the
intake of saturated fatty acids and trans fatty acids should be
as low as possible, since these substances increase the risk of
coronary artery disease. The tolerable upper intake level is
10% of energy intake for saturated fatty acids and 1% of
energy intake for trans fatty acids. Both values were based on
the current tenth percentile of intake in the Netherlands,
which implies that 90% of the Dutch population is advised
to reduce their intake of these fatty acids. The American
committee also recommends that the intake of both groups
of fatty acids be as low as possible, but did not set a tolerable
upper intake level.
Replacing saturated fatty acids by unsaturated fatty acids
can reduce the risk of coronary artery disease. Most of the
fatty acids consumed should therefore be unsaturated. The
Health Council of the Netherlands sees no reason to limit
the intake of monounsaturated fatty acids and considers the
scientific evidence insufficient to set tolerable upper intake
levels for individual polyunsaturated fatty acids. For all
polyunsaturated fatty acids together, the Health Council
recommends a tolerable upper limit of 12% of energy intake.
The adequate intake for linoleic acid is based on the
prevention of deficiency: 2% of energy intake. The American
committee sets the acceptable macronutrient distribution
range for linoleic acid at 5–10% of energy intake; the lower
boundary level is based on the median intake in the United
States and corresponds to the new American adequate
intake, which is formulated in grams per day.
Although some studies suggest that the consumption of
large quantities of a-linolenic acid may increase the risk of
prostate cancer, the Health Council of the Netherlands takes
the view that there is insufficient scientific evidence for this
The new estimated average requirement and recommended
dietary allowance for digestible carbohydrates are based
on the finding that a certain intake level is needed to
minimize the production of glucose from amino acids,
and thus to prevent the breakdown of body protein. The
recommended dietary allowance must therefore be considered a lower limit for the intake of carbohydrates, in analogy
to the recommended dietary allowances for micronutrients.
As a result of this new approach, the sum of the recommended dietary allowances for carbohydrates and proteins
and the adequate intake of fats are less then 100% of energy
intake. (In practice, part of this gap will be filled by
the consumption of alcoholic beverages. According to
the 1998 Dutch Food Consumption Survey, Dutch adults
obtain on average 3–5% of their energy from alcohol). By
not setting an upper limit for carbohydrate intake, the
Health Council of the Netherlands indicates that carbohydrates can be used freely to meet the energy requirements.
The new Dutch recommended dietary allowances for
carbohydrates are lower than the adequate intakes in most
other reports, which treat carbohydrates as a way of
balancing the energy needs. The new American recommended dietary allowances, however, are considerably lower
than the Dutch values, as they are based on the glucose
utilization by the brain. The American committee also
provides an acceptable macronutrient distribution range of
45–65% of energy for carbohydrates, based on minimizing
the risk of coronary heart disease. The lower limit of this
range is 5% higher than the new Dutch recommended
dietary allowance.
Acknowledgements
The Health Council of the Netherlands acknowledges all
members of the Committee on Dietary Reference Intakes and
of the Working Group which prepared the dietary reference
intakes for energy and the macronutrients: Professor Dr HKA
Visser, Chairman of the Committee; Dr H van den Berg;
European Journal of Clinical Nutrition
Dietary reference intakes in the Netherlands
CJK Spaaij and LTJ Pijls
194
Professor Dr PA van den Brandt; BC Breedveld; Professor Dr
RJ Heine; Professor Dr RP Mensink; Professor Dr WHM Saris,
Chairman of the Working Group; Professor Dr HP Sauerwein;
Professor Dr G Schaafsma; Professor Dr JC Seidell; Professor
Dr WA van Staveren; Dr P van’t Veer; Professor Dr CE West;
Dr JA Weststrate; Dr PL Zock.
European Journal of Clinical Nutrition
References
Health Council of the Netherlands (2001): Dietary Reference Intakes:
Energy, Proteins, Fats and Digestible Carbohydrates. Publication no.
2001/19E. The Hague: Health Council of the Netherlands.
Institute of Medicine (2002): Dietary Reference Intakes for Energy,
Carbohydrates, Fiber, Fat, Fatty acids, Cholesterol, Protein and Amino
acids. Washington: National Academy Press.