National Academies Press: OpenBook

Dietary Reference Intakes for Calcium and Vitamin D (2011)

Chapter: Appendix F: Evidence Maps

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Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
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F
Evidence Maps

As part of the committee’s approach to the evaluation of data, evidence maps were developed to assist the committee in organizing its review of the available evidence for each indicator of interest. No effort was made to “fine tune” these maps, but rather they were an initial tool used by the committee to quickly summarize the nature of the available data. The evidence maps below show the evidence from mechanistic and animal data, observational studies, and randomized controlled trials (RCTs). In its evaluation of RCT evidence, the committee considered the study design and whether an indicator was pre-specified as a primary or secondary outcome. Overall, the committee evaluated individual studies and when needed, took methodological differences into account when categorizing a study for inclusion in the evidence maps. However the committee acknowledges the variability in the quality of studies within and across categories, and relied on its expert judgment and a detailed evaluation of each study when drawing conclusions about the relevance and application of an indicator to further consideration in the DRI process. Chapter 4 provides detailed text on each of the key studies that were considered by the committee for the selection of an indicator.

Page 1020 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
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TABLE F-1 Evidence Map for Cancer/Neoplasms

Indicator

Mechanistic Data

Animal Data

Observational Studies

Randomized Trials

Primary Outcome

Secondary or Non–Pre-specified Outcomesa

Calcium

 

 

 

 

 

All cancers

b

b

Breast cancer

Colorectal cancer

b

b

Colorectal adenoma

Prostate cancer

Vitamin D

All cancers

b

Breast cancer

b

Colorectal cancer

b

Colorectal adenoma

b

Prostate cancer

NOTE: = evidence is published; — = no available evidence.

aSecondary outcomes often were not pre-specified by the investigators.

bLimited data.

TABLE F-2 Evidence Map for Cardiovascular Diseases (CVD)/Hypertension

Indicator

Mechanistic Data

Animal Data

Observational Studies

Randomized Trials

Primary Outcome

Secondary or Non–Pre-specified Outcomea

Calcium

b

Vitamin D

b

NOTE: = evidence is published; — = no available evidence.

aSecondary outcomes often were not pre-specified by the investigators.

bLimited data.

TABLE F-3 Evidence Map for Diabetes (Type 2) and Metabolic Syndrome

Indicator

Mechanistic Data

Animal Data

Observational Studies

Randomized Trials

Primary Outcome

Secondary or Non–Pre–specified Outcomesa

Vitamin D

NOTE: = evidence is published; — = no available evidence.

aSecondary outcomes often were not pre-specified by the investigators.

Page 1021 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×

TABLE F-4 Evidence Map for Falls and Physical Performance

Indicator

Mechanistic Data

Animal Data

Observational Studies

Randomized Trials

Primary Outcome

Secondary or Non–Pre-specified Outcomesa

Calcium

Vitamin D

NOTE: = evidence is published; — = no available evidence.

aSecondary outcomes often were not pre-specified by the investigators.

TABLE F-5 Evidence Map for Immune Function

Indicator

Mechanistic Data

Animal Data

Observational Studies

Randomized Trials

Primary Outcome

Secondary or Non–Pre-specified Outcomesa

Vitamin D

 

 

 

 

 

Asthma

Diabetes (Type 1)

Irritable bowel and crohn’s disease

Multiple sclerosis

Rheumatoid arthritis

Systemic lupus erythematosus

Tuberculosis

Influenza/Upper respiratory infections

NOTE: = evidence is published; — = no available evidence.

aSecondary outcomes often were not pre-specified by the investigators.

Page 1022 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×

TABLE F-6 Evidence Map for Neuropsychological Functioning

Indicator

Mechanistic Data

Animal Data

Observational Studies

Randomized Trials

Primary Outcome

Secondary or Non–Pre-specified Outcomesa

Vitamin D

 

 

 

 

 

Autism

Cognitive Function

Depression

NOTE: = evidence is published; — = no available evidence.

aSecondary outcomes often were not prespecified by the investigators.

TABLE F-7 Evidence Map for Preeclampsia of Pregnancy

Indicator

Mechanistic Data

Animal Data

Observational Studies

Randomized Trials

Primary Outcome

Secondary or Non–Pre-specified Outcomesa

Calcium

Vitamin D

NOTE: = evidence is published; — = no available evidence.

aSecondary outcomes often were not pre-specified by the investigators.

Page 1023 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×

TABLE F-8 Evidence Map for Bone Health

Indicator

Mechanistic Data

Animal Data

Observational Studies

Randomized Trials

Primary Outcome

Secondary or Non–Pre-specified Outcomesa

Calcium absorption

Calcium balance

BMD/BMC

Fracture risk

Osteomalacia/rickets

Intermediate

Mechanistic Data

Animal Data

Observational Studies

Randomized Trials

Primary Outcome

Secondary or Non–Pre-specified Outcomesa

25OHD

PTH

NOTE: Data may reflect studies designed to study combined calcium and vitamin D administration, calcium alone, or vitamin D alone. = evidence is published; — = no available evidence.

aSecondary outcomes often were not pre-specified by the investigators.

Page 1024 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×

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Page 1019 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×
Page 1019
Page 1020 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×
Page 1020
Page 1021 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×
Page 1021
Page 1022 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×
Page 1022
Page 1023 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×
Page 1023
Page 1024 Cite
Suggested Citation:"Appendix F: Evidence Maps." Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press. doi: 10.17226/13050.
×
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Calcium and vitamin D are essential nutrients for the human body. Establishing the levels of these nutrients that are needed by the North American population is based on the understanding of the health outcomes that calcium and vitamin D affect. It is also important to establish how much of each nutrient may be "too much."

Dietary Reference Intakes for Calcium and Vitamin D provides reference intake values for these two nutrients. The report updates the DRI values defined in Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, the 1997 study from the Institute of Medicine. This 2011 book provides background information on the biological functions of each nutrient, reviews health outcomes that are associated with the intake of calcium and vitamin D, and specifies Estimated Average Requirements and Recommended Dietary Allowances for both. It also identifies Tolerable Upper Intake Levels, which are levels above wish the risk for harm may increase. The book includes an overview of current dietary intake in the U.S. and Canada, and discusses implications of the study. A final chapter provides research recommendations.

The DRIs established in this book incorporate current scientific evidence about the roles of vitamin D and calcium in human health and will serve as a valuable guide for a range of stakeholders including dietitians and other health professionals, those who set national nutrition policy, researchers, the food industry, and private and public health organizations and partnerships.

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