## Note

1. The upper and lower limit of range doesn’t indicate a clear boundary. Then you should operate flexibly.
2. You should consider the quality of lipid and carbohydrate. It means that it’s required to consider for the composition of fatty acids and saccharides, i.e. saturated fatty acid and dietary fiber.
3. If you attempt to prevent the onset and the aggravation of disease, you should know the actual condition of the nutrient balance and determine the appropriate component ratio.
Energy Production Nutrient Balance (% energy)
Target Amount (Median)
Age Protein Lipid Carbohydrate
Lipid Saturated Fatty Acid
0-11 M
1-17 13-20 (16.5) 20-30 (25) 50-65 (57.5)
18-69 13-20 (16.5) 20-30 (25) ≤ 7 50-65 (57.5)
70- 13-20 (16.5) 20-30 (25) ≤ 7 50-65 (57.5)

Energy production nutrient balance isn’t described in 2010 edition. It’s described in the chapter of carbohydrate as following;

It may be appropriate to set target amount (upper and lower limit) that the appropriate intake of carbohydrate is determined as the difference between the estimated energy requirements and energy derived from enough protein and appropriate lipid.

The purpose of 2015 edition is avoiding of deficiency of various nutrients and prevention of onset and aggravation of lifestyle disease. 2015 edition has formulated the energy production nutrient balance as the ratio (% energy) of protein, lipid and carbohydrate in the total energy intake.

## Energy Conversion Factor

The energy conversion factors of protein, lipid and carbohydrate are 4 kcal/g, 9 kcal/g and 4 kcal/g, respectively. The energy conversion factor of alcohol is 7 kcal/g.

## Protein

The energy production nutrient balance ranges between 13-20 % energy. 13 % energy is equal to the recommended amount of protein and 20 % energy is equal to 2.0 g/kg/d. For elderly, pregnant and lactation, you should be careful not to approach to lower limit of the target amount. Even when energy intake is low, enough protein is required.

## Lipid

The energy production nutrient balance of lipid is 20-30 % energy. 20 % energy is equal to approximate amount of essential fatty acid and 30 % energy is set according to the target amount of saturated fatty acid. The target amount of saturated fatty acid is set to less than 7 % energy from the point of view of prevention of onset and aggravation of myocardial infarction. Although the target amount of SFA for child is not set since they couldn’t obtain evidence, it may be better to care of overdose. And you should be care of the quality of essential fatty acid, i.e. n-3 fatty acid and n-6 fatty acid.

## Carbohydrate

Alcohol is included in carbohydrate. Carbohydrate has been set as the residual of protein and lipid. When protein and lipid approach to lower limit, carbohydrate approaches to 67 % energy, it is not appropriate that the diet with rich carbohydrate may be highly purified cereals, sweeteners and alcohol. Then they have set the upper limit of the target amount of carbohydrate as 65 % energy. On the other hand, when protein and lipid approach to upper limit, the lower limit of the target amount of carbohydrate approaches to 50 % energy and you should be care of the deficiency of dietary fiber.

## Dietary Fiber

Many articles have been reported about the relation between insufficient intake of dietary fiber and lifestyle disease, i.e. myocardial infarction, ischemic stroke, cardiovascular disease, diabetes, breast cancer and gastric cancer. Then the target amount has been set. But the reports about the relation between the intake of dietary fiber and colorectal cancer do not match. It’s unclear that which the intake of dietary fiber in daily life has relation with constipation or not.

In the meta-analysis with trial study, negative correlation has been suggested between the intake amount of dietary fiber and blood pressure, LDL cholesterol and fasting plasma glucose.

In 2015 edition, in order to calculate the dietary reference intakes of dietary fiber, they have compromised of ideal value and reality. Based on the National Health and Nutrition Examination Survey in 2010 and 2011, the median is 13.7 g/d. On the other hand, ideal value besed on the pooled analysis is 24 g/d. The intermediate of them is 18.9 g/d. They have extrapolated body surface area from the ratio of reference weight in each the gender and age groups to reference weight in adult and have set the target amount for each gender and age groups. They have not set the additional amount for pregnant and lactation and they have not set the target amount for child between 1 and 5 years old because it’s difficult to quantify the intake. They don’t ensure the effect of dietary fiber by supplements.

$\displaystyle 18.9\ \mathrm{(g/d)}\times [\mathrm{Reference\ Weight\ (kg)}/57.8\ \mathrm{(kg)}]^{0.75}$
The Dietary Reference Intakes of Dietary Fiber (g/d) (2015 edition)
Gender Male Female
Age Target Amount Target Amount
0-5 M
6-11 M
1-2
3-5
6-7 ≥ 11 ≥ 10
8-9 ≥ 12 ≥ 12
10-11 ≥ 13 ≥ 13
12-14 ≥ 17 ≥ 16
15-17 ≥ 19 ≥ 17
18-29 ≥ 20 ≥ 18
30-49 ≥ 20 ≥ 18
50-69 ≥ 20 ≥ 18
70- ≥ 19 ≥ 17
Pregnant
Lactation

The Dietary reference Intakes of dietary fiber in 2010 edition is based on the article, Dietary Fiber and Risk of Coronary Heart Disease, in which the reduction of the mortality has been suggested in more than 24 g/d intake group and the increase of mortality has been suggested in less than 12 g/d group. They had set the intermediate value, 18 g/d, as reference. In the National Health and Nutrition Examination Survey in 2005 and 2006, the median intake is 12.3-16.3 g/d in adult male and 11.8-16.1 g/d in adult female, respectively. Then it seems to be determined that the ideal value 24 g/d is not practical for most Japanese.

The Dietary Reference Intakes of Dietary Fiber (g/d) (2010 edition)
Gender Male Female
Age Target Amount Target Amount
0-5 M
6-11 M
1-2
3-5
6-7
8-9
10-11
12-14
15-17
18-29 ≥ 19 ≥ 17
30-49 ≥ 19 ≥ 17
50-69 ≥ 19 ≥ 17
70- ≥ 19 ≥ 17
Pregnant
Lactation

## Dietary Fiber and Risk of Coronary Heart Disease

This article has reported the association between dietary fiber intakes and the risk of cardiovascular disease, that it has been shown that total fiber intakes, cereal fiber intakes and fruit fiber intakes have inverse association, in contrast, vegetable fiber has no association.

In the Dietary Reference Intakes for Japanese 2015 edition, they have described “If they would intake 24 g/d or greater of dietary fiber, they could avoid the risk of coronary death.”, but I couldn’t find the describe in the original article.

# Dietary Fiber and Risk of Coronary Heart Disease

## A pooled Analysis of Cohort Studies

Mark A. Pereira, PhD; Eilis O’Reilly, MSc; Katarina Augustsson, PhD; Gary E. Fraser, MBChB, PhD; Uri Goldbourt, PhD; Berit L. Heitmann, PhD; Goran Hallmans, MD, PhD; Paul Knekt, PhD; Simin Liu, MD, ScD; Pirjo Pietinen, DSc; Donna Spiegelman, ScD; June Stevens, MS, PhD; Jarmo Virtamo, MD; Walter C. Willett, MD; Alberto Ascherio, MD

Background Few epidemiologic studies of dietary fiber intake and risk of coronary heart disease have compared fiber types (cereal, fruit, and vegetable) or included sex-specific results. The purpose of this study was to conduct a pooled analysis of dietary fiber and its subtypes and risk of coronary heart disease.

Methods We analyzed the original data from 10 prospective cohort studies from the United States and Europe to estimate the association between dietary fiber intake and the risk of coronary heart disease.

Results Over 6 to 10 years of follow-up, 5249 incident total coronary cases and 2011 coronary deaths occurred among 91 058 men and 245 186 women. After adjustment for demographics, body mass index, and lifestyle factors, each 10-g/d increment of energy-adjusted and measurement error–corrected total dietary fiber was associated with a 14% (relative risk [RR], 0.86; 95% confidence interval [CI], 0.78-0.96) decrease in risk of all coronary events and a 27% (RR, 0.73; 95% CI, 0.61-0.87) decrease in risk of coronary death. For cereal, fruit, and vegetable fiber intake (not error corrected), RRs corresponding to 10-g/d increments were 0.90 (95% CI, 0.77-1.07), 0.84 (95% CI, 0.70-0.99), and 1.00 (95% CI, 0.88-1.13), respectively, for all coronary events and 0.75 (95% CI, 0.63-0.91), 0.70 (95% CI, 0.55-0.89), and 1.00 (95% CI, 0.82-1.23), respectively, for deaths. Results were similar for men and women.

Conclusion Consumption of dietary fiber from cereals and fruits is inversely associated with risk of coronary heart disease.

Arch Inern Med. 2004; 164: 370-376