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According to the American Academy of Pediatrics, the goal of pediatrics is “to attain optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults.” It is self-evident that maintaining good nutrition is a prerequisite to attaining this goal. Appropriate nutrition supplies the “building blocks” for healthy physical growth. Optimal mental health and mental capacity rely on adequate nutrition, from conception to old age. D.J.P. Barker theorized that fetal nutrition is associated with a number of chronic conditions of later life. The Barker hypothesis, in its expanded form, proposes that infant nutrition, as well as fetal nutrition, has long-term health effects reaching into adulthood and old age. Some of the parameters that may be affected by nutrition in infancy include cardiovascular health, blood pressure, bone mineralization, low-density lipoprotein cholesterol, split proinsulin, and cognitive development. While these observations are tantalizing, they are observational. A causal relationship has not been established. The Barker hypothesis continues to be debated, but to the extent that it proves true, early nutrition gains tremendous importance.

Much of the early work on establishing nutritional requirements focused on preventing diseases and deficiencies. It was assumed that if a child were given adequate amounts and varieties of foods, good nutrition would automatically follow. The present obesity epidemic that has affected all age groups in our society has proven this assumption incorrect. It has become clear that we need to monitor the nutritional health of our youth and encourage good nutrition for all. In order to accomplish this, we must know the nutritional requirements for optimal growth and to avoid future nutrition-related complications, not merely to avoid deficiency states.

Recommended Dietary Allowances (RDAs) were first established in 1941 and first published in 1943. The RDAs were based on scientific evidence and intended to serve as goals for good nutrition. Over the years the RDAs have changed according to the needs of the country. When first devised, the country was struggling with war-time shortages and the RDAs were used to guide priorities and to avoid widespread deficiencies in groups of people. Over time, the emphasis changed to goals for individuals. The eighth edition of the RDAs published in 1974 included the following definition of RDA: “the levels of essential nutrients that, on the basis of scientific knowledge, are judged by the Food and Nutrition Board to be adequate to meet the known nutrient needs of practically all healthy persons.” The exception to the “practically all healthy persons” rule is the RDA for energy. Since it would not be reasonable to recommend the high end of the distribution curve for energy, in this case the RDA was set at approximately the average. Planning for the present Dietary Reference Intakes (DRIs), that have superseded the RDAs, began in 1993 with the realization that RDAs need to be “continuously” updated rather than periodically reviewed and updated and that values beyond RDAs were necessary. Among other things, Upper Limits ...

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