Article

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

ABSTRACT 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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    • "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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    • "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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