Article

Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK et al.. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96, 53-58

Department of Nutritional Sciences, Pennsylvania State University, University Park, Pennsylvania 16802, USA.
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.21). 06/2011; 96(1):53-8. DOI: 10.1210/jc.2010-2704
Source: PubMed

ABSTRACT

This article summarizes the new 2011 report on dietary requirements for calcium and vitamin D from the Institute of Medicine (IOM). An IOM Committee charged with determining the population needs for these nutrients in North America conducted a comprehensive review of the evidence for both skeletal and extraskeletal outcomes. The Committee concluded that available scientific evidence supports a key role of calcium and vitamin D in skeletal health, consistent with a cause-and-effect relationship and providing a sound basis for determination of intake requirements. For extraskeletal outcomes, including cancer, cardiovascular disease, diabetes, and autoimmune disorders, the evidence was inconsistent, inconclusive as to causality, and insufficient to inform nutritional requirements. Randomized clinical trial evidence for extraskeletal outcomes was limited and generally uninformative. Based on bone health, Recommended Dietary Allowances (RDAs; covering requirements of ≥97.5% of the population) for calcium range from 700 to 1300 mg/d for life-stage groups at least 1 yr of age. For vitamin D, RDAs of 600 IU/d for ages 1-70 yr and 800 IU/d for ages 71 yr and older, corresponding to a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/liter), meet the requirements of at least 97.5% of the population. RDAs for vitamin D were derived based on conditions of minimal sun exposure due to wide variability in vitamin D synthesis from ultraviolet light and the risks of skin cancer. Higher values were not consistently associated with greater benefit, and for some outcomes U-shaped associations were observed, with risks at both low and high levels. The Committee concluded that the prevalence of vitamin D inadequacy in North America has been overestimated. Urgent research and clinical priorities were identified, including reassessment of laboratory ranges for 25-hydroxyvitamin D, to avoid problems of both undertreatment and overtreatment.

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    • "Serum 25OHD3 levels 20 ng/ mL were considered as vitamin D deficiency, while levels between 20 and 30 ng/mL as vitamin D insufficiency, 30 and 80 ng/mL as optimal vitamin D level and !80 ng/mL as potential vitamin D toxicity [21] "
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    • "Indeed, at least two 25OHD cut-offs, 20 and 30 ng/mL, are debated. The 20 ng/mL cut-off is supported by the Institute of Medicine (IOM) report which is targeted towards the general (healthy) population in order to define optimal vitamin D intake (which intake is necessary so that most individuals in the general population have a 25OHD concentration at or above 20 ng/mL?) [14]. The 30 ng/mL cut-off is supported by the Endocrine Society and is intended for the care Table 1 Reference ranges (ng/L) proposed by kit manufacturers of 10 PTH kits compared with the reference ranges established in our laboratory with the same kits in the same group of 240 healthy subjects (120 women, 120 men) with a 25OHD concentration > 30 ng/mL and an eGFR (MDRD formula) > 60 mL/mn/1.73 "
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    • "It is responsible for maintaining the structural integrity of bones and teeth; plays role in various metabolic processes as an enzyme cofactor and a signaling molecule . A Ca deficient diet leads to reduced bone density, increased risk of bone fracture and osteoporosis in humans (Ross et al., 2011; Singh et al., 2013). Dairy products have been one of the main sources of Ca in human diets. "
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