Dávkování vitamínu E a různé normy a doporučení
Převody jednotek - obsahu vitaminu E have
- Mg, µmol, alpha-TEs, international units (IU)
Alpha-TEs6
- The alpha-TEs were defined in the 1989 RDA
- But were not used in the 2000 DRI for vitamin E [7]
- Factors to convert tocopherols and tocotrienols to alpha-TEs6
- Based on the bioactivity of these tocopherols and tocotrienols
- Assessed using the resorption–gestation test in rats (IOM, 2000) [2]
- Instead milligrams of 2R-alpha-tocopherol was defined as the vitamin E unit [7]
- Alpha-TEs fell out of favor because non–alpha-tocopherols are rapidly metabolized, do not substitute for alpha-tocopherol, and cannot be metabolically converted to alpha-tocopherol by humans and therefore should not be included in measures of vitamin E intake [7]
IU
- United States Pharmacopeia (USP)
- Defined the IU for vitamin E (USP, 1979, 1980)
- Expressed it relative to the synthetic form, racemic all-rac-alpha-tocopheryl acetate [2]
mg
IOM (2000)
- Difference in relative activity of all-rac-alpha-tocopherol compared with RRR-alpha-tocopherol
- Is 50 %
- 1 mg all-rac-alpha-tocopherol = 0.5 mg RRR-alpha-tocopherol [2]
mg - IU
%%h4- 1 IU all-rac-alpha-tocopherol or its esters = 0.45 mg 2R-stereoisomeric forms of alpha-tocopherol
- 1 IU RRR-alpha-tocopherol or its esters = 0.67 mg 2R-alpha-tocopherol (EFSA Panel agrees) [2]
mg/l tp mol/l
- Convert serum tocopherol values from mg/L to mol/L, multiply by 2.322 [5]
Correction of plasma alpha-tocopherol concentrations for lipids
- Is not appropriate in cases in which circulating lipids are below normal concentrations [7]
- Both malnutrition and infectious diseases can lower circulating cholesterol and its lipoprotein carriers [7]
Adequate Intakes (AIs)
- Based on observed intakes in healthy populations with no apparent aplha-tocopherol deficiency in the EU [2] (EFSA)
Adults alpha-tocopherol
- 13 mg/day for men
- 11 mg/day for women [2]
Children
1 - 3 years
- 6 mg/day for both sexes [2]
Children 3 - 10 years
- 9 mg/day for both sexes [2]
Children 10 - 18 years
- 13 mg/day for boys
- 11 mg/day for girls [2]
Infants 7–11 months
- 5 mg/day
- Derived by extrapolating upwards from the estimated ?-tocopherol intake in exclusively breast-fed infants aged 0–6 months and rounding [2]
Pregnant or lactating women
- No evidence for an increased dietary alpha-tocopherol requirement [2]
- Full compensation of the transitory secretion of alpha-tocopherol in breast milk is not justified for the derivation of DRVs for alpha-tocopherol for lactating women. [2]
EFSA Adequate Intake (AI)
- For alpha-tocopherol for all population groups based on observed intakes in healthy populations with no apparent alpha-tocopherol deficiency
- Current intake levels are adequate
- Except for infants aged 7–11 months [2]
Average Requirements (ARs)
EAR for vitamin E
- Was set in humans on the basis of vitamin E depletion and repletion studies in men with the use of erythrocyte hemolysis as the biomarker
- The RDA of 15 mg ?-tocopherol was extrapolated from that value (IOM2000) [7]
Inadequacy
- Can be determined from “low” values
- Urinary excretion of the vitamin E metabolite alpha-carboxy-ethyl-hydroxychromanol may fulfill biomarker role
- Has not been widely studied with regard to vitamin E status in humans or with regard to health benefits [7]
- Nad 90% of Americans do not consume sufficient dietary vitamin E to meet estimated average requirements (EARs)
- They appear to undergo no obvious ill effects
- Their circulating alpha-tocopherol concentrations are not obviously abnormal.
- EAR is too high and that this apparent low dietary alpha-tocopherol intake has no biologic significance ?? [7]
- 90% of men and 96% of women do not consume the EAR of 12 mg alpha-tocopherol [7]
No Observed Adverse Effect Level (NOAEL)
SCF (2003)
- 540 mg alpha-TE/day (study by Meydani et al. (1998))
- 88 healthy subjects over 65 years of age received for 4 months
- Placebo
- 40
- 134
- 537 mg alpha-TE/day (all-rac-alpha-tocopherol) [2]
- Develop no adverse effects, including bleeding time
Novorozenci
- Premature neonates may require supplementation, human milk and commercial formulas have enough vitamin E for full-term neonates [9]
Population Reference Intakes (PRIs)
- For vitamin E (as alpha-tocopherol)
- Cannot be derived for adults, infants and children
1988 - 1994, the US National Health and Nutrition Examination Survey III (NHANES III)
- Dietary intake and blood concentrations of alpha-tocopherol in 16,295 adults
- One-third of all participants had
- Blood concentrations of alpha-tocopherol below 20 micromoles/liter (µmol/L)
- Its initial association with an increased risk for cardiovascular disease [10]
18,063 participants in NHANES 2003-2006
- Average dietary intake of alpha-tocopherol from food (including enriched and fortified sources) among Americans adults
- 7.2 mg/day
- Well below the current recommended dietary allowance of 15 mg/day (RDA)
- More than 93% of American adults do not meet the estimated average requirement (EAR) of 12 mg/day for vitamin E [10]
Tolerable Upper Intake Level (UL)
SCF (2003)
- Impact on blood clotting as the critical adverse effect
- Adults of 270 mg alpha-TE/day, rounded to 300 mg alpha-TE/day
- Uncertainty factor of 2
- Pregnant and lactating women [2]
- Children
- Derived from the adult UL
- By allometric scaling on the basis of body weight to the power of 0.75
- 100 mg alpha-TE/day (1–3 years)
- 260 mg alpha-TE/day (15–17 years) [2]
Alpha-tocopherol in adults
- 1,000 mg/day of all possible stereoisomers of alpha-tocopherol [10]
Food and Nutrition Board of the Institute of Medicine
- Any form of supplemental alpha-tocopherol (all possible stereoisomers)
- To avoid the potential risk of bleeding
- UL of 1,000 mg/day of alpha-tocopherol in any supplemental form equivalent to
- 1,500 IU/day of RRR-alpha-tocopherol
- 1,100 IU/day of all-rac-alpha-tocopherol
- Highest dose unlikely to result in hemorrhage in almost all adults [10]
Adequacy of human vitamin E status
- Cannot be assessed from circulating alpha-tocopherol concentrations
- Circulating alpha-tocopherol concentrations are very difficult to interpret
- As a person ages, plasma lipid concentrations also increase
- These elevations in lipids increase the plasma carriers for alpha-tocopherol
- Leading to higher circulating alpha-tocopherol concentrations
- Abnormal lipoprotein metabolism
- Does not necessarily increase alpha-tocopherol delivery to tissues. [7]
Děti - doporučený příjem vit. E
EFSA
AIs in mg alpha-TE/day
Children aged 1–14 years, D-A-CH (2015)
- By interpolation between the AI for infants and that for adults.
The Nordic countries (Nordic Council of Ministers, 2014)
- Based their RIs for infants and children on the
- ‘vitamin E’ concentration of human milk
- The relationship between alpha-TE, linoleic acid or total PUFAs (Aggett et al., 1998)
- A ratio of at least 0.6 mg alpha-TE/g PUFAs
- Average PUFA intake corresponding to 5 % of energy intake.
WHO/FAO (2004)
- AI of 2.7 mg alpha-TE/day for infants
Afssa (2001)
- Derived PRIs for children from the adult value, adjusted for energy requirement.
IOM (2000)
- Infants aged 7–11 months
- AI of 5 mg alpha-tocopherol/day by allometric scaling (body weight to the power of 0.75, using reference body weights from NHANES III 1988–1994, and rounding up)
- Intake of younger infants
- Calculated considering a
- For children aged 1–18 years, no data were available on which to base EARs
- Derived from the adult EAR by allometric scaling (body weight to the power of 0.75, using reference body weights from NHANES III 1988–1994 and growth factors)
- RDAs were derived from the EARs by assuming a CV of 10 %.
The SCF (1993)
- Diet containing 0.4 mg alpha-TE/g PUFAs (as for adults) seemed also adequate for infants aged 6–11 months and children
- No information on the basal requirement for the vitamin in case of a very low PUFA intake.
Netherlands Food and Nutrition Council (1992)
- Infants older than six months and children
- PRI of 0.67 mg alpha-TE/g PUFAs as for adults.
UK COMA (DH, 1991)
- ‘safe intake’ of 0.4 mg alpha-TE/g PUFAs
- Infant formulae should not contain less than this amount (DHSS, 1980)
- No DRVs were set for children.
EFSA 2015 Infants
- EFSA intake estimates in infants
- AI for older infants (7–11 months) [2]
- Based on estimated alpha-tocopherol intakes of breast-fed younger infants and upwards extrapolation. [2]
- Assuming an average breast milk alpha-tocopherol concentration of 4.6 mg/L in mature human milk of unsupplemented mothers of term infants
- Average breast milk intake of infants aged 0–6 months of 0.8 L/day (Butte et al., 2002; FAO/WHO/UNU, 2004; EFSA NDA Panel, 2009) [2]
- Estimated alpha-tocopherol intake of infants in the first half-year of life is 3.7 mg/day
- Averages of the median weight-for-age of male and female infants aged [2]
- Three months (6.1 kg) [2]
- Nine months (8.6 kg) according to the WHO Growth Standards (WHO Multicentre Growth Reference Study Group, 2006) [2]
- AI for alpha-tocopherol for infants aged 7–11 months [2]
- 5 mg/day. [2]
- AI infants 7–11 months [2]
- = alpha-tocopherol intakeinfants 0–6 months × (weight infants 9 months/weight infants 3 months) x 0.75 [2]
EFSA 2015 Children
- Children aged 1 to pod 3 years in EU countries
- Average alpha-tocopherol intakes
- 4 - 5 mg/day in girls
- 4.5 - 5.7 mg/day in boys [2]
- Average alpha-TE intakes
- 4.4 - 6.8 mg/day in girls
- 4.7 - 7.3 mg/day in boys [2]
- AI for alpha-tocopherol
- 6 mg/day for both sexes for children aged 1 - 3 years.
- Children aged 3 - 10 years in EU
- Average alpha-tocopherol intakes
- 5.4 - 10.3 mg/day in girls
- 5.8 - 10.9 mg/day in boys
- Average alpha-TE intakes
- 6.5 - 11.8 mg/day in girls [2]
- 7.1 - 12.4 mg/day in boys
- AI for alpha-tocopherol [2]
- 9 mg/day for both sexes for children 3 -10 years.[2]
- Children aged 10-18 years in EU countries
- Average alpha-tocopherol intakes
- 8.2 - 13.2 mg/day in girls
- 9.1 - 14.3 mg/day in boys
- Average alpha-TE intakes
- 8.8 - 13.8 mg/day in girls
- 9.6 - 15.9 mg/day in boys [2]
- AI for alpha-tocopherol
- 11 mg/day for girls
- 13 mg/day for boys [2]
Dietary intake
Mean alpha-tocopherol intakes in adults in some European countries (Finland, Sweden) (Amcoff et al., 2012; Helldán et al., 2013)
- Higher than those observed in the USA
- Gamma-tocopherol intakes are generally reported to be higher than in the EU (Gao et al., 2004; Maras et al., 2004; Dixon et al., 2006; Mahabir et al., 2008; Signorello et al., 2010; Yang et al., 2014a; Yang et al., 2014b). [2]
- Alpha-tocopherol intakes in Europe (EFSA, 2011b)
- Most food composition databases in EU countries still contain values for ‘vitamin E’ as alpha-tocopherol equivalents (alpha-TEs)
- Only two countries, Finland and Sweden, the national database compilers indicated to EFSA that the vitamin E values in their food composition databases were alpha-tocopherol values [2]
- Finland, France, Germany, Ireland, Italy, Latvia, the Netherlands, Sweden and the UK between 2000 and 2012 (EFSA, 2011a) [2]
Average alpha-tocopherol intakes
- In infants (1–11 months)
- 2.9 - 4.9 mg/day in girls
- 3.2 - 5.4 mg/day in boys
- Children aged 1 to pod 3 years
- 4 - 5 mg/day in girls
- 4.5 - 5.7 mg/day in boys
- Children aged 3 to pod 10 years
- 5.4 - 10.3 mg/day in girls
- 5.8 - 10.9 mg/day in boys
- Children aged 10 to pod 18 years
- 8.2 - 13.2 mg/day in girls
- 9.1 - 14.3 mg/day in boys
- Adults (nad 18 years)
- 7.8 - 12.5 mg/day in women
- 8.2 - 16 mg/day in men [2]
- Alpha-Tocopherol values were missing for 796 foods, for which imputation of missing composition values was undertaken by EFSA. [2]
Dietary intake of alpha-tocopherol equivalents (alpha-TEs)
- Estimates for average alpha-TE intakes in all included countries, expressed in mg/day and mg/MJ
- In infants (1–11 months)
- 3.2 - 5.3 mg/day in girls
- 3.4 - 5.9 mg/day in boys
- Children aged 1 to pod 3 years,
- 4.4 and 6.8 mg/day in girls
- 4.7 and 7.3 mg/day in boys
- Children aged 3 to pod 10 years
- 6.5 and 11.8 mg/day in girls
- 7.1 and 12.4 mg/day in boys
- Children aged 10 to pod 18 years
- 8.8 and 13.8 mg/day in girls
- 9.6 and 15.9 mg/day in boys
- Adults
- 8.9 and 13.5 mg/day in females
- 10.1 and 16.0 mg/day in males. [2]
- Vegetable fats and oils, grains and grain-based products and the sum of fruits and vegetables and derived products
- Main food groups contributing to alpha-TE intakes in all sex and age groups
- Analytical or estimation/calculation method applied for the determination of the values
- Alpha-TE values were missing for 796 foods, for which imputation of missing composition values was undertaken by EFSA. [2]
Dop. dávka v ekvivalentech alpha tokoferolu při konzumaci PUFA dle SCF
- 0.4 mg alpha-tocopherol equivalents (alpha-TEs) per gram of dietary polyunsaturated fatty acids (PUFAs) [2]
Dospělí - doporučený příjem
German-speaking countries (D-A-CH, 2015)
Adequate Intakes (AIs)
- 12–15 mg alpha-TE/day for men
- 11–12 mg alpha-TE/day for women according to age
- Based on:
- ‘basal requirement’ of 4 mg alpha-TE/day for adults
- Independently of unsaturated fat intake
- Assuming that 0.06, 0.4 and 0.6 mg alpha-TE are required to protect 1 g of fatty acid with one, two or three double bonds from oxidation (Horwitt, 1974; Witting and Lee, 1975)
- Intake of PUFAs with more double bounds would increase the AI by about 0.5 mg alpha–TE/day. [2]
Nordic countries (Nordic Council of Ministers, 2014)
- Maintained their previous Recommended Intake (RI)
- RIs apply to 2R-isomers of alpha-tocopherol only (RRR-, RSR-, RRS- and RSS)
- Nordic countries considered possible cut-off values for plasma alpha-tocopherol concentration to assess status (12 or 16.2 micromol/L) (Horwitt et al., 1963; Morrissey and Sheehy, 1999)
- Mean alpha-tocopherol intakes and plasma concentrations in Nordic populations (Piironen et al., 1984; Wallstrom et al., 2001; Ylonen et al., 2003; Tomten and Hostmark, 2009)
- Possible ratios of
- 0.6 mg alpha-TE/g PUFAs (Valk and Hornstra, 2000)
- 0.4 mg alpha-TE/g PUFAs (SCF, 1993)
- Based on a ratio of 0.4 mg alpha-TE/g PUFAs and an average PUFA intake of 5 % of energy intake [2]
ARs and RIs were set at:
- ARs 5 and RIs 8 mg alpha-TE/day for women
- ARs 6 and RIs 10 mg alpha-TE/day for men [2]
Lower intake level
- 3 and 4 mg alpha-TE/day for women and men [2]
World Health Organization (WHO/FAO, 2004)
- Data were not sufficient to set a PRI for ‘vitamin E’
- Mentioned median intakes in the
- UK (10 and 7 mg alpha-TE/day for men and women DH, 1991)
- USA (10 and 8 mg alpha-TE/day for men and women NRC, 1989)
- Proposed ‘best estimates of requirements’ of 10 and 7.5 mg alpha-TE/day for men and women [2]
French Food Safety Agency (Afssa, 2001)
- Retained its previous reference value from 1992 of 12 mg/day ‘vitamin E (tocopherol)’ for men and women
- Adults aged 75 years and over 20–50 mg/day in relation to possible benefits [2]
IOM (2000)
Recommended Dietary Allowance (RDA)
- Naturally occurring form (RRR-)
- Synthetic 2R-stereoisomers (RSR-, RRS- and RSS-) of alpha-tocopherol
- Other naturally occurring tocopherols and tocotrienols (beta-, gamma- and delta-tocopherols and the tocotrienols) are not converted to alpha-tocopherol by humans
- Are recognised poorly by the alpha-TTP in the liver [2]
Estimated Average Requirement (EAR)
- 12 mg alpha-tocopherol/day
- Based on data on induced deficiency in men (Horwitt et al., 1956; Horwitt, 1960, 1962; Horwitt et al., 1963; Horwitt et al., 1972; Horwitt, 1974; Farrell et al., 1977)
- IOM used and adapted data from Horwitt et al. (1963) (instead of Farrell et al. (1977)
- Plasma alpha-tocopherol concentration of 12 micromol/L was associated with in vitro hydrogen peroxide-induced haemolysis below 12 % (which was considered normal)
- IOM determined that plasma alpha-tocopherol concentration was above the cut-off of 12 micromol/L for an intake of at least 12 mg alpha-tocopherol/day [2]
- Similar data were not available for women or for older adults
- Concluded that there was no scientific basis for assuming different requirements for these population groups
- Ratio of at least 0.4 mg alpha-tocopherol per gram of PUFAs for adults (Bieri and Evarts, 1973; Horwitt, 1974; Witting and Lee, 1975) and mean PUFA intakes from National Health and Nutrition Examination Survey (NHANES) II (Murphy et al., 1990), was considered to be covered by the EAR of 12 mg alpha-tocopherol/day [2]
RDA
- 15 mg alpha-tocopherol/day for adults
- Derived from the EAR by assuming a coefficient of variation (CV) of 10 %. [2]
SCF (1993)
- Concentrations higher than
- 11.6 micromol/L for plasma tocopherol
- 2.25 micromol serum tocopherol/mmol cholesterol (values below which the erythrocytes tend to have a reduced survival time in vivo (Horwitt, 1980a)) [2]
- Are maintained in men on low PUFA intakes for intakes of about 3 mg alpha-TE/day (Bunnell et al., 1975)
- Requirement as 0.4 mg alpha-TE/g PUFAs (Bieri and Evarts, 1973; Witting and Lee, 1975)
- Intake of the vitamin should be above
- 4 mg alpha-TE/day for men
- 3 mg alpha-TE/day for women
- Women were considered to have lower PUFA amounts in their tissues because of their smaller body size than men. [2]
Netherlands Food and Nutrition Council (1992)
- ‘vitamin E’ amount to attain a plasma ‘vitamin E’ concentration of at least 11.6 micromol/L would be the requirement
- 0.4 mg alpha-TE/g PUFAs (Horwitt et al., 1972; Horwitt, 1974; Farrell, 1980; Horwitt, 1980b)
- At low PUFA intake, the diet should provide at least 4 mg alpha-TE/day [2]
PRI was defined
- Quantity to maintain plasma ‘vitamin E’ concentrations considered as normal on average 24.4 micromol/L (range: 11.6–37.1 micromol/L). -
- Was maintained by an average intake of 0.67 mg alpha-TE/g PUFAs (Horwitt et al., 1972; Horwitt, 1974; Farrell, 1980; Horwitt, 1980b). [2]
UK COMA (DH, 1991)
- Could not set DRVs for ‘vitamin E’
- Considered that intakes above
- 4 mg alpha-TE/day (men)
- 3 mg alpha-TE/day (women) could be adequate
- Based on observed intakes in the UK (Black et al., 1986; Gregory et al., 1990) [2]
- Range of PUFA intake was wide in the UK
- Average ‘vitamin E’ amounts required for adults consuming the DRVs for PUFAs (0.4 mg alpha-TE/g PUFAs) were below average UK intakes (Gregory et al., 1990). [2]
EFSA 2015 adults (over 18 years)
- In EU countries
- Average alpha-tocopherol intakes
- 7.8 - 12.5 mg/day in women
- 8.2 and 16 mg/day in men [2]
- Average alpha-TE intakes
- 8.9 and 13.5 mg/day in women
- 10.1 and 16.0 mg/day in men [2]
- AI for alpha-tocopherol
- 13 mg/day for men
- 11 mg/day for women. [2]
- These AIs are close to or above the intakes that are suggested from available studies on markers of alpha-tocopherol intake/status or on alpha-tocopherol kinetics and body pools [2]
Legislativa
- Regulation (EC) No 1925/2006 of the European Parliament and of the Council of 20 December 2006 on the addition of vitamins and minerals and of certain other substances to foods, OJ L 404, 30.12.2006, p. 26.
- Directive 2002/46/EC of the European Parliament and of the Council of 10 June 2002 on the approximation of the laws of the Member States relating to food supplements, OJ L 183, 12.7.2002, p. 51.
- Alpha-Tocopherol pod 20 %
- Beta-tocopherol pod 10 %
- Gamma-tocopherol 50–70 %
- Delta-tocopherol 10–30 % [2]
- Commission Directive 2006/141/EC of 22 December 2006 on infant formulae and follow-on formulae and amending Directive 1999/21/EC, OJ L 401, 30.12.2006, p. 1. and Commission Directive 2006/125/EC of 5 December 2006 on processed cereal-based foods and baby foods for infants and young children, OJ L 339, 06.12.2006, p. 16.
- Dietary Reference Values for vitamin E as alpha-tocopherol
- Assumed that the best intake estimates would be obtained when both the consumption data and the composition data are from the same country.
- EFSA estimates are based on consumption of foods, either fortified or not, but without taking dietary supplements into account
Minimal intake regardless of PUFA intake dle SCF
- 4 mg alpha-TE/day for men
- 3 mg alpha-TE/day for women [2]
Pregnancy and lactation
D-A-CH (2015)
AI
- 13 mg alpha-TE/day for pregnant women
- 17 mg alpha-TE/day for lactating women
- Increased energy requirement
- Concomitant higher intake of unsaturated fatty acids
- Lactating women AI to cover the additional requirement of 0.26 mg alpha-TE/100 g of secreted milk. [2]
The Nordic countries (Nordic Council of Ministers, 2014)
- RI of 10 mg alpha-TE/day last two trimesters of pregnancy
- Cover the increased intake of energy and PUFAs
- RI of 11 mg alpha-TE/day for lactating women
- To cover secretion of the vitamin in human milk. [2]
IOM (2000)
- Increase in blood concentrations of alpha-tocopherol and total lipids during pregnancy (Horwitt et al., 1972)
- Constant placental transfer of the vitamin (Abbasi et al., 1990)
- Lack of reported deficiency of the vitamin during pregnancy
- Set the same EAR and RDA as for non-pregnant women [2]
IOM
- RDA of 19 mg alpha-tocopherol/day for lactating women
- EAR for non-lactating women the average amount of about 4 mg alpha-tocopherol/day secreted in human milk using a CV of 10 %. [2]
Netherlands Food and Nutrition Council (1992)
- Increased plasma concentrations of ‘vitamin E’ and lipids during pregnancy
- Low placental transfer of the vitamin (Takahashi et al., 1978; Haga et al., 1982)
- Considered the same PRI as for other adults (0.67 mg alpha-TE/g PUFA) [2]
- Lactation
WHO/FAO (2004)
- Did not report specific reference values for pregnant or lactating women
- There was no evidence that the requirement for the vitamin was different in pregnant or lactating women compared with other women
- Increased energy intake would likely compensate for the increased needs for infant growth and milk synthesis [2]
Afssa (2001) and SCF (1993)
- Did not identify evidence for a different requirement for the vitamin in pregnant or lactating women compared with other women [2]
DH (1991) did not set specific DRVs for pregnant or lactating women
- Minimal intake set for non-pregnant non-lactating women (i.e. above 3 mg alpha-TE/day) applies. [2]
EFSA
- Secretion of alpha-tocopherol in mature human milk
- During the first six months
- Estimated 3.7 mg/day
- Increase in the percentage of RBC haemolysis up to ‘high’ values took several months in depleted men receiving a basal diet providing about 3 mg/day of alpha-tocopherol
- Available data do not indicate an additional dietary alpha-tocopherol requirement during lactation.
EFSA 2015 Lactation
- Secretion of alpha-tocopherol in milk during the first 6 months of lactation in exclusively breastfeeding women
- About 3.7 mg/day
- Average alpha-tocopherol absorption from a usual diet of about 75%
- Additional intake of 4.9 mg alpha-tocopherol/day would be assumed
- With the aim of fully compensating the amount of alpha-tocopherol secreted in human milk
- Proposed AI for (non-lactating) women, derived from observed intakes in the EU
- Is close to or above the intakes suggested from available studies on markers of alpha-tocopherol intake/status or on alpha-tocopherol kinetics and body pools [2]
- Size of the theoretical alpha-tocopherol store in adipose tissue
- Increase in the percentage of RBC haemolysis up to ‘high’ values took several months in depleted men receiving a basal diet providing about 3 mg/day of alpha-tocopherol [2]
- Full compensation of the transitory loss of alpha-tocopherol in breast milk
- Is not justified for the derivation of DRVs for alpha-tocopherol for lactating women
- AI for alpha-tocopherol for lactating women is the same as for non-lactating women
- 11 mg/day [2]
EFSA 2015 Pregnancy
- No evidence for an increased dietary alpha-tocopherol requirement in pregnancy
- AI alpha-tocopherol as for non-pregnant women
- 11 mg/day [2]
- EFSA intake assessment for the Latvian survey on pregnant adult women are
- 12.4 and 12.5 mg/day (Appendices D and F). [2]
Lack of convergence of the values
- From the use of data on markers of alpha-tocopherol intake/status
- Alpha-tocopherol kinetics and body pools
- PUFA intake
- Alpha-tocopherol intake and health consequences are inconsistent or limited
- Cannot be used to derive the requirement for alpha-tocopherol
- No data that can be used to derive the requirement for alpha-tocopherol for infants or children
