The 2011 Dietary Reference Intakes for Calcium and Vitamin D: What Dietetics Practitioners Need to Know

The Pennsylvania State University, University Park, PA, USA.
Journal of the American Dietetic Association (Impact Factor: 3.92). 04/2011; 111(4):524-7. DOI: 10.1016/j.jada.2011.01.004
Source: PubMed


The Institute of Medicine Committee to Review Dietary Reference Intakes for Calcium and Vitamin D comprehensively reviewed the evidence for both skeletal and nonskeletal health outcomes and concluded that a causal role of calcium and vitamin D in skeletal health provided the necessary basis for the 2011 Estimated Average Requirement (EAR) and Recommended Dietary Allowance (RDA) for ages older than 1 year. For nonskeletal outcomes, including cancer, cardiovascular disease, diabetes, infections, and autoimmune disorders, randomized clinical trials were sparse, and evidence was inconsistent, inconclusive as to causality, and insufficient for Dietary Reference Intake (DRI) development. The EAR and RDA for calcium range from 500 to 1,100 and 700 to 1,300 mg daily, respectively, for ages 1 year and older. For vitamin D (assuming minimal sun exposure), the EAR is 400 IU/day for ages older than 1 year and the RDA is 600 IU/day for ages 1 to 70 years and 800 IU/day for 71 years and older, corresponding to serum 25-hydroxyvitamin D (25OHD) levels of 16 ng/mL (40 nmol/L) for EARs and 20 ng/mL (50 nmol/L) or more for RDAs. Prevalence of vitamin D inadequacy in North America has been overestimated based on serum 25OHD levels corresponding to the EAR and RDA. Higher serum 25OHD levels were not consistently associated with greater benefit, and for some outcomes U-shaped associations with risks at both low and high levels were observed. The Tolerable Upper Intake Level for calcium ranges from 1,000 to 3,000 mg daily, based on calcium excretion or kidney stone formation, and from 1,000 to 4,000 IU daily for vitamin D, based on hypercalcemia adjusted for uncertainty resulting from emerging risk relationships. Urgently needed are evidence-based guidelines to interpret serum 25OHD levels relative to vitamin D status and intervention.

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Available from: A. Catharine Ross, Oct 01, 2015
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    • "While it is possible that the intervention did not adequately stimulate bone, our lack of ability to detect DXA-derived bone mass differences between groups is potentially a function of the relatively small subsample who were willing to attend the densitometry laboratory for measures. Calcium intake (CON 1150 mg/day, EX 850 mg/day) was somewhat lower than the current Recommended Dietary Allowance (RDA), which is 1300 mg per day for children from nine to thirteen years old, although CON reached the Estimated Average requirement (EAR) of 1100 mg per day [51] [52]. That our exercise intervention effected positive change in the girls in the intervention group, despite lower than recommended calcium intake, is encouraging in light of the common notion that between 850 and 1000 mg of calcium per day is required for an exercise effect in children [53] [54]. "
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    ABSTRACT: Unlabelled: The CAPO Kids trial was a 9-mo, controlled, school-based intervention to examine the effects of a novel, brief, high intensity exercise regime on indices of musculoskeletal and metabolic health in pre- and early-pubertal girls. Methods: A total of 151 pre- and early-pubertal girls (10.6±0.6years), recruited from two different schools consented to participate; 76 in the exercise group (EX) and 75 in the control group (CON). EX performed 10min bouts of thrice-weekly jumping plus capoeira (a Brazilian sport that combines martial art with dance), along with usual physical education (PE) activities. CON continued usual PE alone. Maturity, weight, height, waist circumference, resting heart rate and blood pressure, maximal vertical jump, and aerobic capacity were determined using standard clinical and field measures. Calcaneal broadband ultrasound attenuation (BUA) and stiffness index (SI) were determined from quantitative ultrasonometry. A subsample of children also underwent DXA and pQCT measures. Prior physical activity participation and daily calcium consumption were determined from validated instruments. Results: EX girls improved BUA more than CON (+4.5% vs. +1.4%, p=0.019). Resting heart rate (-7.2% vs. -1.8%, p<0.01), maximal vertical jump (+13.4% vs. -1.2%, p<0.001), estimated maximal oxygen consumption (+10.6% vs. +1.0%, p<0.001), and waist circumference (+2.7% vs. +5.6%, p<0.001) also improved more for EX than CON. Conclusion: Ten minutes of high intensity exercise (capoeira and jumping) three times a week in the primary school setting enhances musculoskeletal and metabolic outcomes in pre- and early-pubertal girls without disrupting the academic schedule. The programme, amenable to broad-scale school implementation, would confer meaningful public health benefits.
    Bone 08/2014; 68. DOI:10.1016/j.bone.2014.08.006 · 3.97 Impact Factor
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    • "The vitamin D currently added to foods and the use of vitamin D as a replacement therapy have been shown not to eliminate vitamin D insufficiency [24] or vitamin D deficiency [25,26]. The Institute of Medicine of the National Academies in the United States of America, in its latest report of 2011, recommended increasing the nutritional dose of vitamin D from 400 to 600 IU for children older than one year of age [27]. We concur that it is necessary to increase the vitamin D dose, the period of exposure to sunlight, and the time of exposure to sunlight (preferably around midday). "
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    ABSTRACT: Epidemiological studies show that vitamin D deficiency and insufficiency are common worldwide and associated with many diseases including asthma. Our aim was to evaluate vitamin D insufficiency and its clinical consequences. This cross-sectional study was carried out on 170 children consisted of 85 who were asthmatic and 85 who were not, aged 2 to 14 years in Tekirdag, Turkey, from September 2009 to May 2010. Children's basal serum D vitamin levels were determined, and their eating habits, vitamin D intake, exposure to sunlight and use of health services during the previous year were investigated. The severity of asthma and levels of asthma control were assessed according to the Global Initiative for Asthma guidelines. The difference between mean vitamin D levels in the asthmatic group (mean +/- SD) 16.6 +/- 8.5 ng/mL and the healthy control group (mean +/- SD) 28.2 +/- 19.5 ng/mL was found to be statistically significant (p < 0.001). Children in the asthma group had less exposure to sunlight and ate a diet less rich in vitamin D (p < 0.001). A significant difference was observed between the groups regarding the frequency of respiratory tract infections leading to emergency unit admissions and number of hospitalizations (p < 0.001). It was also shown that a decrease in vitamin D level increased the severity of asthma (p < 0.001) and decreased the frequency of controlled asthma (p = 0.010). This study has demonstrated the correlation between plasma 25 (OH) D levels and childhood asthma. Evidently, this relationship being influenced by multiple factors other than vitamin D, further studies should be conducted to explore the interrelation between all such factors.
    Italian Journal of Pediatrics 12/2013; 39(1):78. DOI:10.1186/1824-7288-39-78 · 1.52 Impact Factor
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    • "In a previous murine study, smooth muscle cell-specific Runx2 deletion was found to inhibit high fat diet induced VC [52]. In the present study, despite increased serum calcium or Alp levels, the protective effects on VC in Vdr-/- and Runx2+/ΔC mice indicate that both Vdr and Runx2 act independently of these factors, which suggests that vitamin D daily allowances be strictly adhered to particularly CKD patients [32]. Alp activity was not changed by vitamin D3 in neither Vdr-/- or Runx2+/ΔC mice, but an increase was observed in WT mice. "
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    ABSTRACT: The transdifferentiation of vascular smooth muscle cells (VSMCs) into osteoblast-like cells has been implicated in the context of vascular calcification. We investigated the roles of vitamin D receptor (Vdr) and runt-related transcription factor 2 (Runx2) in the osteoblastic differentiation of VSMCs in response to vitamin D3 using in vitro VSMCs cultures and in vivo in Vdr knockout (Vdr (-/-) ) and Runx2 carboxy-terminus truncated heterozygous (Runx2 (+/ΔC) ) mice. Treatment of VSMCs with active vitamin D3 promoted matrix mineral deposition, and increased the expressions of Vdr, Runx2, and of osteoblastic genes but decreased the expression of smooth muscle myosin heavy chain in primary VSMCs cultures. Immunoprecipitation experiments suggested an interaction between Vdr and Runx2. Furthermore, silencing Vdr or Runx2 attenuated the procalcific effects of vitamin D3. Functional cooperation between Vdr and Runx2 in vascular calcification was also confirmed in in vivo mouse models. Vascular calcification induced by high-dose vitamin D3 was completely inhibited in Vdr (-/-) or Runx2 (+/ΔC) mice, despite elevated levels of serum calcium or alkaline phosphatase. Collectively, these findings suggest that functional cooperation between Vdr and Runx2 is necessary for vascular calcification in response to vitamin D3.
    PLoS ONE 12/2013; 8(12):e83584. DOI:10.1371/journal.pone.0083584 · 3.23 Impact Factor
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