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in France: the first edition was published in

1981 [8], the second one in 1992 [9] and

the last edition in 2001 [12]. The latter edi- tion results from work carried out over four years by 89 specialists and was reviewed by more than one hundred experts. By con- trast, the United States have recently pub- lished the 11th edition of their national ref- erences [11]. However, this delay does not represent an exception in Europe: publica- tions on this topic have only been found in Italy [17], Germany (in association with1. INTRODUCTION

The ANC or "apports nutritionnels con-

seillés" for the French population are refer- ence values which are used in France to assess the nutritional quality of actual dietary intakes of populations or groups, for its ade- quacy to physiological requirements, or to conceive diets or foods to satisfy these requirements.

From a historical point of view, the elab-

oration of such references has been delayed Review articleThe "apports nutritionnels conseillés (ANC)" for the French populationAmbroise MARTIN* French Food Safety Agency (AFSSA), 23 avenue du Général de Gaulle, BP19,

94701 Maisons-Alfort Cedex, France

(Received 13 February 2001; accepted 2 April 2001) Abstract - The apports nutritionnels conseillés (ANC) for the French population are the reference which are used in France to assess the nutritional status of the population. These references have

been elaborated by a transparent and collective expert process, conferring on them an official refer-

ence. The originality of the French method was to add to the classical analysis of each nutrient an anal-

ysis concerning both a global approach to specific groups (children, pregnant women, elderly people, sportsmen) and the links between nutrients and foods. Many original works, which have been specif- ically performed for this revision, highlight the absolute need for rigorous evaluation of food consumption patterns and for valuable food composition tables. nutrition / reference dietary intake / requirement / French population / nutritional status

Reprod. Nutr. Dev. 41 (2001) 119-128 119

© INRA, EDP Sciences, 2001

Presented at the "Journées Francophones de Nutrition", Tours, France, 2000. * Correspondence and reprints

E-mail: a.martin@afssa.fr

A. Martin120

Austria and Switzerland [7]), the United

Kingdom [3], the European Union ([4], for

the French edition) and the Scandinavian countries (1996).

Reasons for such a delay are certainly

diverse, some of which could be more spe- cific to French culture: perhaps it was thought for a long time that in the country of "fine cuisine", nutritional problems could not occur; research in nutrition, despite noticeable pioneering studies, has only recently begun to reach an international level; moreover, interest in public health is not well developed in our country. Nutri- tion has only recently become a public health concern, when France proposed this issue as a main area of concern during its presidency of the European Union in the second part of year 2000. This new approach in public health led to the publication of a long report by the Haut Comité de la

Santé Publique (High Committee for Public

Health [10]).

Several factors put forward the argument

for periodic reexaminations of dietary ref- erence values: the rapid increase in the knowledge of nutrition and in the links between nutrition and health; the current modifications in food consumption patterns; the acceleration of food innovation in the food industry, which is seeking to promote its products on the basis of their nutritional quality (food fortification, functional foods, nutraceuticals...).

2. CONCEPT EVOLUTION

In France as well as in foreign countries,

the aim of dietary reference values has clearly evolved from the consideration of the prevention of inadequacy (health pro- tection) to the issue of health promotion.

Following the sharp decline, and even the

disappearance, of clinical forms of nutri- tional deficiencies, the aim is now to develop reference values which could prevent, or at

least, decrease the risk of, degenerativedisorders which are drastically increasingin developed countries, such as cancer, car-diovascular diseases, diabetes and osteo-porosis.

This conceptual change raises new prob-

lems, since many more works have to be taken into account, especially the numer- ous reports of intervention studies which are performed around the world. The main problem lies in the extrapolation to the

French population of results obtained in

countries where the basal rates of some dis- eases are very different and where usual dietary patterns are quite different.

Such difficulties justify the development

of a French reflexion on the issue of dietary reference values, insofar as the national con- text, in terms of regulatory corpus or nutri- tion philosophy, could occupy an important place. Despite an actual convergence in the values proposed by different countries, there are still discrepancies, which could induce non negligible consequences: through these values, and the need to reach them to encourage (or not) food fortification, dietary supplements or new health products, the relation of a population towards its food per- ception could be progressively modified.

Finally, it must also be taken into account

that scientific data form the basis of the international regulations at the World Trade

Organisation. Promotion of specific posi-

tions must receive strong scientific support.

3. OBJECTIVES AND METHODS

OF THE REVISION OF ANC

At the beginning of this work by the end

of 1996, several objectives were assigned to this revision and corresponding method- ologies were developed: - to provide a French edition readily available for anyone interested in the nutri- tion field; - to properly present the basis of the reference values in order to make explicit the strength of the scientific support for the The "apports nutritionnels conseillés (ANC)" for the French population - ANC (apports nutritionnels conseillés for the French population) as the intake nec- essary to cover the physiological require- ments of almost every individual in the pop- ulation (97.5%), given as the value of the average nutritional requirement, to which are added two standard deviations of 15% each, characterising and assuming normal statistical distribution; therefore, ANC remain reference values for a population and are only indicative for individuals; in any case, they do not imply that every indi- vidual must reach these values or that they are sufficient for every individual in any sit- uation; moreover, ANC are designed only for healthy people; - average nutritional requirement, cal- culated as the mean of requirements of a (varying) number of individuals. It is obtained from the net requirement taking into account the average bioavailability of the nutrient in a "usual" diet; - net requirement, as the amount of a given nutrient required to satisfy various needs (maintenance, metabolic and physi- ological functioning of the organism), if necessary including requirements accord- ing to specific situations (growth, pregnancy, lactation); - optimal requirement: this notion goes beyond physiology and considers quality of life in the long term ("successful aging"), including risk reduction for degenerative diseases involving nutritional factors. It is proposed that ANC represent optimal values at a population level in the present state of knowledge, not precluding complementa- tion or supplementation requirements for some individuals in a specific context; - safety limits, using the definition and values proposed by the French High Coun- cil for Public Hygiene [5] and corresponding to the maximum amount of a given nutri- ent which could be consumed every day throughout life without any identified health concern. This does not imply that such an amount is useful or without risk, but that no risk has been detected and published so far,values. Besides the classical analysis of international scientific literature, original works from data obtained on the French population were specifically developed for this revision; - to ensure a better coherence between analytical approaches to nutrients and global approaches for population groups. Work- ing groups for these two approaches were culturally different: people trained in the basic sciences for the first type of approach and physicians for the second. The balance between the various arguments was not auto- matically the same, especially for the issues where the margin of interpretation was quite large (in the case of calcium, vitamin D, or E, in elderly people for example). Reach- ing an agreement between the two cultures on a single value was considered as the best compromise achievable with the current state of knowledge; - to validate methodologies and results via collective expert appraisal. Namely, three steps of discussion and validation were fol- lowed: at the level of working groups (also using expert people outside the groups); at the level of the pilot committee in charge of coherence of the global work; at the level of national committees, competent in the nutrition and food area, such as the French

High Council for Public Hygiene (CSHPF,

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