Excerpt

The charge to the committee (Institute of Medicine Committee to Review Dietary Reference Intakes for Vitamin D and Calcium) was to assess current relevant data and update, as appropriate, the DRIs (Dietary Reference Intakes) for vitamin D and calcium. The review was to include consideration of chronic disease indicators (e.g., reduction in risk of cancer) and other (non-chronic disease) indicators and health outcomes. The definitions of these terms are discussed below. Consistent with the framework for DRI development, the indicators to assess adequacy and excess intake were to be selected based on the strength and quality of the evidence and their demonstrated public health significance, taking into consideration sources of uncertainty in the evidence. Further, the committee deliberations were to incorporate, as appropriate, systematic evidence-based reviews of the literature.

Specifically, in carrying out its work, the committee was to:

• Review evidence on indicators to assess adequacy and indicators to assess excess intake relevant to the general North American population, including groups whose needs for or sensitivity to the nutrient may be affected by particular conditions that are widespread in the population such as obesity or age-related chronic diseases. Special groups under medical care whose needs or sensitivities are affected by rare genetic disorders or diseases and their treatments were to be excluded;
• Consider systematic evidence-based reviews, including those made available by the sponsors as well as others, and carefully document the approach used by the committee to carry out any of its own literature reviews;
• Regarding selection of indicators upon which to base DRI values for adequate intake, give priority to selecting indicators relevant to the various age, gender, and life stage groups that will allow for the determination of an Estimated Average Requirement (EAR);
• Regarding selection of indicators upon which to base DRI values for upper levels of intake, give priority to examining whether a critical adverse effect can be selected that will allow for the determination of a so-called benchmark intake;
• Update DRI values, as appropriate, using a risk assessment approach that includes (1) identification of potential indicators to assess adequacy and excess intake, (2) selection of the indicators of adequacy and excess intake, (3) intake-response assessment, (4) dietary intake assessment, and (5) risk characterization.
• Identify research gaps to address the uncertainties identified in the process of deriving the reference values and evaluating their public health implications.

Contents

• The National Academies
• Committee to Review Dietary Reference Intakes for Vitamin D and Calcium
• Reviewers
• Preface
• Summary
  • THE COMMITTEE AND ITS CHARGE
  • DRI CONTEXT FOR COMMITTEE'S WORK
  • THE COMMITTEE'S APPROACH AND EXAMINATION OF DATA
  • KEY CHALLENGES
  • THE COMMITTEE'S OUTCOMES
  • DIETARY INTAKE ASSESSMENT
  • IMPLICATIONS AND SPECIAL CONCERNS
  • CONCLUSIONS ABOUT VITAMIN D DEFICIENCY IN THE UNITED STATES AND CANADA
• 1. Introduction
  • THE TASK
  • THE DIETARY REFERENCE INTAKE FRAMEWORK
  • THE APPROACH
  • REFERENCES
• 2. Overview of Calcium
  • INTRODUCTION
  • SOURCES OF CALCIUM
  • METABOLISM OF CALCIUM
  • FUNCTIONS AND PHYSIOLOGICAL ACTIONS OF CALCIUM
  • CALCIUM ACROSS THE LIFE CYCLE
  • BONE MASS MEASURES ASSOCIATED WITH CALCIUM
  • OTHER FACTORS RELATED TO CALCIUM NUTRITURE
  • REFERENCES
• 3. Overview of Vitamin D
  • INTRODUCTION
  • SOURCES OF VITAMIN D
  • METABOLISM OF VITAMIN D
  • FUNCTIONS AND PHYSIOLOGICAL ACTIONS OF VITAMIN D
  • VITAMIN D ACROSS THE LIFE CYCLE
  • MEASURES ASSOCIATED WITH VITAMIN D: SERUM 25OHD
  • MEASURES ASSOCIATED WITH VITAMIN D: PARATHYROID HORMONE
  • REFERENCES
• 4. Review of Potential Indicators of Adequacy and Selection of Indicators: Calcium and Vitamin D
  • APPROACH
  • REVIEW OF POTENTIAL INDICATORS
  • CONSIDERATIONS RELATED TO AFRICAN AMERICAN ANCESTRY
  • SELECTION OF INDICATORS
  • REFERENCES
• 5. Dietary Reference Intakes for Adequacy: Calcium and Vitamin D
  • OVERVIEW
  • CALCIUM: DIETARY REFERENCE INTAKES FOR ADEQUACY
  • VITAMIN D: DIETARY REFERENCE INTAKES FOR ADEQUACY
  • REFERENCES
• 6. Tolerable Upper Intake Levels: Calcium and Vitamin D
  • CALCIUM UPPER LEVELS: REVIEW OF POTENTIAL INDICATORS AND SELECTION OF INDICATORS
  • CALCIUM UPPER LEVELS: INTAKE-RESPONSE ASSESSMENT AND SPECIFICATION OF UPPER LEVELS
  • VITAMIN D UPPER LEVELS: REVIEW OF POTENTIAL INDICATORS AND SELECTION OF INDICATORS
  • VITAMIN D UPPER LEVELS: INTAKE-RESPONSE ASSESSMENT AND SPECIFICATION OF UPPER LEVELS
  • REFERENCES
• 7. Dietary Intake Assessment
  • THE NATIONAL SURVEYS AND APPROACH USED
  • CALCIUM INTAKE
  • VITAMIN D INTAKE AND SERUM 25OHD CONCENTRATIONS
  • DIFFERENCES BETWEEN THE UNITED STATES AND CANADA: NATIONAL SURVEY DATA FOR CALCIUM AND VITAMIN D
  • SUMMARY
  • REFERENCES
• 8. Implications and Special Concerns
  • SUMMARY OF ASSESSMENT
  • IMPLICATIONS
  • POPULATION SEGMENTS AND CONDITIONS OF INTEREST
  • REFERENCES
• 9. Information Gaps and Research Needs
  • STEP 1 “HAZARD IDENTIFICATION” OR INDICATOR REVIEW AND SELECTION
  • STEP 2 “HAZARD CHARACTERIZATION” OR INTAKE-RESPONSE ASSESSMENT AND SPECIFICATION OF DIETARY REFERENCE INTAKES
  • STEP 3 INTAKE ASSESSMENT
  • RELATED RESEARCH NEED
  • CONCLUDING REMARKS
  • REFERENCES
• Appendixes
  • A Acronyms, Abbreviations, and Glossary
  • B Issues and Interests Identified by Study Sponsors
  • C Methods and Results from the AHRQ-Ottawa Evidence-Based Report on Effectiveness and Safety of Vitamin D in Relation to Bone Health
  • D Methods and Results from the AHRQ-Tufts Evidence-Based Report on Vitamin D and Calcium
  • E Literature Search Strategy
  • F Evidence Maps
  • G Cases Studies of Vitamin D Toxicity
  • H Estimated Intakes of Calcium and Vitamin D from National Surveys
  • I Proportion of the Population Above and Below 40 nmol/L Serum 25-Hydroxyvitamin D Concentrations and Cumulative Distribution of Serum 25-Hydroxyvitamin D Concentrations: United States and Canada
  • J Workshop Agenda and Open Session Agendas
  • K Biographical Sketches of Committee Members
• Summary Tables

This study was supported by Contract No. 4500196976 between the National Academy of Sciences and Health Canada; Contract No. 59-0204-8-155 between the National Academy of Sciences and the U.S. Department of Agriculture, Agriculture Research Service; Contract No. CNPP-08-0001 between the National Academy of Sciences and the U.S. Department of Agriculture (Center for Nutrition Policy and Promotion); Contract No. W81XWH-09-1-0288 between the National Academy of Sciences and the U.S. Department of the Army; Contract No. HHSF223200811157P between the National Academy of Sciences and the U.S. Department of Health and Human Services, Food and Drug Administration; Contract No. N01-OD-4-2139 between the National Academy of Sciences and the U.S. Department of Health and Human Services (National Institutes of Health); Contract No. HHSP223200800002T between the National Academy of Sciences and the U.S. Department of Health and Human Services (Office of Disease Prevention and Health Promotion).

Suggested citation:

IOM (Institute of Medicine). 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press.

Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.