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Title: The 2011 dietary reference intakes for calcium and vitamin D: what dietetics practitioners need to know

Author
item ROSS, A - Pennsylvania State University
item MANSON, JOANN - Brigham & Women'S Hospital
item ABRAMS, STEVEN - Children'S Nutrition Research Center (CNRC)
item ALOIA, JOHN - State University Of New York (SUNY)
item BRANNON, PATSY - Cornell University
item CLINTON, STEVEN - The Ohio State University
item DURAZO-ARVIZU, RAMON - Loyola Stritch School Of Medicine
item GALLAGHER, J - Creighton University
item GALLO, RICHARD - University Of California
item JONES, GLENVILLE - Queen'S University - Canada
item KOVACS, CHRISTOPHER - Memorial University Of Newfounland
item MAYNE, SUSAN - Yale School Of Medicine
item ROSEN, CLIFFORD - Maine Medical Center Research Institute (MMCRI)
item SHAPSES, SUE - Rutgers University

Submitted to: Journal of American Dietetic Association
Publication Type: Review Article
Publication Acceptance Date: 12/15/2010
Publication Date: 4/1/2011
Citation: Ross, A.C., Manson, J.E., Abrams, S.A., Aloia, J.F., Brannon, P.M., Clinton, S.K., Durazo-Arvizu, R.A., Gallagher, J.C., Gallo, R.L., Jones, G., Kovacs, C.S., Mayne, S.T., Rosen, C.J., Shapses, S.A. 2011. The 2011 dietary reference intakes for calcium and vitamin D: what dietetics practitioners need to know. Journal of American Dietetic Association. 111(4):524-527.

Interpretive Summary:

Technical 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.