What is the Chronic Disease Risk Reduction (CDRR)?
The Chronic Disease Risk Reduction (CDRR) Intake is a new addition to the Dietary Reference Intakes (DRIs) framework, developed by the National Academies of Sciences, Engineering, and Medicine. A CDRR is defined as the level of intake above which reducing intake is expected to decrease the risk of developing a specific chronic disease within a healthy population.
This expands upon the traditional focus of DRIs, which historically concentrated on preventing nutrient deficiencies (like the Recommended Dietary Allowance, or RDA) and avoiding toxicity from excessive intake (the Tolerable Upper Intake Level, or UL). The CDRR emphasizes using nutrition to prevent chronic illnesses such as cardiovascular disease and hypertension. Establishing a CDRR involves a rigorous, systematic review of scientific evidence, requiring at least a moderate strength of evidence demonstrating both a causal relationship and an intake-response relationship between a nutrient and a chronic disease outcome.
The Sodium CDRR: A Landmark Example
The sodium CDRR is a key illustration of this new guideline. Based on extensive evidence linking high sodium intake to increased blood pressure, cardiovascular disease, and hypertension, the sodium CDRR for adults is set at 2,300 mg/day. This level indicates that reducing sodium intake from above this amount is expected to lower the risk of these chronic diseases.
This has major public health implications, as a large majority of the population in countries like the U.S. and Canada consumes sodium above the 2,300 mg/day threshold. This high intake contributes to the prevalence of hypertension and cardiovascular disease. The sodium CDRR provides a clear, evidence-based target for public health efforts and dietary guidance aimed at reducing population-wide sodium intake. The focus is on reducing intake from high levels down to the CDRR, as opposed to necessarily aiming for intakes below this level, for which the evidence regarding chronic disease outcomes is less established.
How the CDRR Compares to Other DRIs
The CDRR complements the other components of the DRI framework rather than replacing them. Each DRI category addresses a different aspect of nutritional health.
| DRI Category | Primary Purpose | How It's Established | Application | Nutrients |
|---|---|---|---|---|
| Estimated Average Requirement (EAR) | Meets needs of 50% of a healthy group. | Based on extensive scientific data on nutrient requirements. | Used to assess and plan diets for population groups. | Macronutrients, many vitamins and minerals. |
| Recommended Dietary Allowance (RDA) | Meets needs of 97-98% of a healthy group. | Set at the EAR + two standard deviations to cover most individuals. | A daily intake goal for individuals. | Macronutrients, many vitamins and minerals. |
| Adequate Intake (AI) | Assumed to ensure adequacy when RDA cannot be determined. | Based on observed average intake levels of healthy populations. | Used as a goal for individual intake when an RDA is unavailable. | Calcium, Vitamin D, others where data is limited. |
| Tolerable Upper Intake Level (UL) | Maximum intake unlikely to cause toxic adverse health effects. | Based on toxicity studies (NOAEL/LOAEL) and uncertainty factors. | A warning to individuals and professionals about excessive intake, especially from supplements. | Vitamins, minerals. |
| Chronic Disease Risk Reduction (CDRR) | Intake above which chronic disease risk is reduced by lowering intake. | Requires moderate to high strength of evidence for a causal and intake-response relationship. | A public health target for population-level risk reduction. | Currently only sodium. |
Using the CDRR in Practice
The CDRR provides a clear, action-oriented guideline for both public health initiatives and individuals:
- Public health initiatives: The sodium CDRR highlights excessive sodium intake as a public health issue. This can inform government campaigns and food regulations to encourage sodium reduction in the population. Reducing sodium in processed foods, a major source, is a key strategy.
- Individual consumers: For those with high sodium intake, the CDRR offers a clear goal for dietary improvement. It helps consumers understand that their current intake may increase their chronic disease risk and that dietary changes can be beneficial. Reducing high-sodium processed foods, restaurant meals, and snacks can help lower intake towards the 2,300 mg goal.
- Dietitians and healthcare providers: These professionals can use the CDRR for patient counseling, providing an evidence-based target for discussing dietary changes, particularly for individuals at risk of cardiovascular disease or hypertension. It offers a framework for preventive nutrition beyond just preventing deficiencies.
- Product developers: The CDRR can guide food manufacturers in developing and reformulating products with lower sodium content, making healthier choices more accessible.
Conclusion: Looking Beyond Adequacy
The sodium CDRR represents a significant expansion of the DRI framework, incorporating the proactive reduction of chronic disease risk alongside the traditional goals of preventing nutrient deficiency and toxicity. By offering a clear, science-backed target for sodium intake, the CDRR serves as a valuable tool for public health officials, healthcare providers, and individuals. It emphasizes the evolving role of nutrition in overall health, highlighting diet as a key strategy for long-term chronic disease prevention. Future research may lead to the establishment of CDRR values for other nutrients and health outcomes.
Authoritative outbound link: {Link: National Academies Press nap.nationalacademies.org/resource/25353/interactive/}.
