Cover Image

HARDBACK
$69.95



View/Hide Left Panel

5
Dietary Reference Intakes for Adequacy: Calcium and Vitamin D

OVERVIEW

Bone health has been selected as the indicator to serve as the basis of the Dietary Reference Intakes (DRIs) for calcium and vitamin D. The review that underpins this conclusion has been described in Chapter 4, the component of this report addressing the hazard identification step of risk assessment and specifying the selected indicator. The next step in the risk assessment approach for DRI development—the hazard characterization component of risk assessment—is contained in this chapter. The dose–response relationship between the nutrient intake and bone health is examined and dietary reference values for adequacy are specified. In the case of DRIs for calcium and vitamin D, such values take the form of Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) or, alternatively, Adequate Intakes (AIs). The discussions related to the Tolerable Upper Intake Level (UL), which is also a DRI value, are contained in Chapter 6.

Currently available data on bone health outcomes—when considered as an integrated body of evidence—can be used to derive EARs and RDAs for calcium and vitamin D for all life stages except infants. Bone health measures associated with bone accretion, bone maintenance, and bone loss are relevant to different DRI life stages, and thus the indicator of bone health has been reflected by different bone health measures depending upon the life stage. With respect to infants 0 to 12 months of age, for whom data were very sparse, an AI can be specified for each nutrient based on the available evidence concerning levels of intake observed to be adequate.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 345
5 Dietary Reference Intakes for Adequacy: Calcium and Vitamin D OVERVIEW Bone health has been selected as the indicator to serve as the basis of the Dietary Reference Intakes (DRIs) for calcium and vitamin D. The re- view that underpins this conclusion has been described in Chapter 4, the component of this report addressing the hazard identification step of risk assessment and specifying the selected indicator. The next step in the risk assessment approach for DRI development—the hazard characterization component of risk assessment—is contained in this chapter. The dose– response relationship between the nutrient intake and bone health is ex- amined and dietary reference values for adequacy are specified. In the case of DRIs for calcium and vitamin D, such values take the form of Estimated Average Requirements (EARs) and Recommended Dietary Allowances (RDAs) or, alternatively, Adequate Intakes (AIs). The discussions related to the Tolerable Upper Intake Level (UL), which is also a DRI value, are contained in Chapter 6. Currently available data on bone health outcomes—when considered as an integrated body of evidence—can be used to derive EARs and RDAs for calcium and vitamin D for all life stages except infants. Bone health measures associated with bone accretion, bone maintenance, and bone loss are relevant to different DRI life stages, and thus the indicator of bone health has been reflected by different bone health measures depending upon the life stage. With respect to infants 0 to 12 months of age, for whom data were very sparse, an AI can be specified for each nutrient based on the available evidence concerning levels of intake observed to be adequate. 345

OCR for page 345
346 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D The DRIs for calcium and vitamin D established in 1997 (IOM, 1997) also relied on bone health as the indicator in setting reference values for adequacy. However, the 1997 report established an AI for all life stage groups; no EARs or RDAs were specified. Newer data plus an integration of data have allowed the estimation of EARs and RDAs for all life stages except infants. Quantitative comparisons between AIs and EARs and RDAs are not appropriate. In 1997, AIs were established for calcium in lieu of EARs and RDAs as a result of uncertainties associated with balance studies, lack of concordance between observational and experimental data, and lack of longitudinal data to verify the relationship between calcium intake, calcium retention and bone loss (IOM, 1997). In the past 10 years, newer evidence on skeletal health has emerged from a combination of large-scale randomized trials and calcium balance studies as described in Chapter 4. Further, there are now data relative to a number of life stage groups, and these help to avoid reliance on extrapolating or scaling data from one life stage to another unstudied life stage. In the case of vitamin D, the 1997 report concluded that there were inadequate data available for EARs and RDAs as a result of uncertainties about sun exposure, the vitamin D content of the diet, and vitamin D stores (IOM, 1997). In the intervening years data have emerged that allow a re- quirement distribution to be simulated for vitamin D, which, in turn, has been found to be concordant with other available data. This analysis unex- pectedly indicated that the dose–response relationship regarding median requirements is not significantly affected by age. Further, several newer studies can be used to elucidate the contributions made by sun exposure and to help separate total intake contributions from contributions stem- ming from cutaneous synthesis. Strides have been made in estimating the vitamin D content of foods as well as the amounts of vitamin D consumed by the U.S. and Canadian populations. Despite new data since the earlier Institute of Medicine (IOM) report (IOM, 1997), there remain a number of uncertainties that have caused challenges in estimating DRI values for calcium and vitamin D. Notable among these is the absence of intervention trials that study dose–response relationships for the nutrients. Rather, most of the evidence is derived from a single dose that is often relatively high. Further, some studies fail to specify information about the background diet and hence the total level of intake is lacking. When this is the case, the mean population requirement may be below the dose used in the study, but cannot be further specified. In addition, there is the common practice of designing studies to examine calcium and vitamin D in combination, thereby precluding the ability to discern the effects of each nutrient alone, which is of interest when estab- lishing a reference value for a nutrient.

OCR for page 345
347 DIETARY REFERENCE INTAKES FOR ADEQUACY As discussed in Chapter 4, there are very limited data to suggest that there may be some biological differences in the way in which different ethnic/racial groups respond to calcium and vitamin D, most notably among those of African American ancestry. The extent to which such observations may affect requirements for the nutrients is unknown at this time. Although it is important to take into account biological differences where they may exist among, for example, African Americans, Hispanics, and those of Asian descent, the available data are too limited to permit the committee to assess whether separate, quantitative reference values for such groups are required. The DRIs established in this report are based on the current understanding of the biological needs for calcium and vitamin D across the North American population. Other factors may come into play in terms of ensuring adequate intakes of these nutrients—for example, lactose intolerance or food choices—but as far as is known these factors do not affect the basic biological need for these nutrients. Rather, they are discussed in Chapter 8 as issues relevant to the application of the DRIs by dietary practitioners. Described in this chapter is the committee’s decision-making regarding the dose–response relationships for calcium and bone health, and for vita- min D and bone health. From these conclusions, DRI values for adequacy are specified. A significant underlying assumption made by the committee is that the DRIs for calcium are predicated on intakes that meet require- ments for vitamin D and that the DRIs for vitamin D rest on the assumption of intakes that meet requirements for calcium. In other words, the require- ment for one nutrient assumes that the need for the other nutrient is being met. This is an essential assumption, for three reasons: 1. Given that reference values are intended to act in concert for the purposes of planning diets, health policy makers would be working to meet all nutritional needs; therefore it would be inappropriate to establish requirements for such purposes on the basis that one or more related nutrients would be consumed by the population in inadequate amounts. 2. An inadequacy in one of the nutrients could cause changes in the efficient handling of or physiological response to the other nutrient that might not otherwise be present. For example, in vi- tamin D–deficient states with minimal calcium intake, absorption of calcium from the gut cannot be enhanced. The compensatory metabolic response to this scenario is the accelerated conversion of 25-hydroxyvitamin D (25OHD) to its active form (calcitriol) through an increase in parathyroid hormone (PTH) levels. Such perturbations confound the estimation of the true requirement under neutral circumstances.

OCR for page 345
348 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D 3. No amount of vitamin D is able to compensate for inadequate to- tal calcium intake; thus, setting a realistic DRI value for vitamin D requires that calcium is available in the diet in adequate amounts. However, the committee has also commented on the consequences for one nutrient when the other is inadequate, in order to be transparent regarding the science underpinning the determination of reference values for these two nutrients. CALCIUM: DIETARY REFERENCE INTAKES FOR ADEQUACY The EARs, RDAs, and AIs for calcium are shown in Table 5-1 by life stage group. The studies used to estimate these values have been included in the review of potential indicators contained in Chapter 4. Therefore, in the discussions below, the relevant data are highlighted but not specifically critiqued again. Infants 0 to 12 Months of Age Infants 0 to 6 Months of Age AI 200 mg/day Calcium Infants 6 to 12 Months of Age AI 260 mg/day Calcium Data are not sufficient to establish an EAR for infants 0 to 6 and 7 to 12 months of age, and therefore AIs have been developed based on the available evidence. An AI value is not intended to signify an average requirement, but instead reflects an intake level based on approximations or estimates of nutrient intakes that are assumed to be adequate. Whether and how much the AI values for infants could be lowered and still meet the physiological needs for human milk-fed infants are unknown because mechanisms for adaptation to lower intakes of calcium are not well de- scribed for the infant population, and experimental data with overall rel- evance to estimating average requirements are extremely limited. Calcium requirements for infants are presumed to be met by human milk (IOM, 1997). There are no functional criteria for calcium status that reflect response to calcium intake in infants (IOM, 1997). Rather, human milk is recognized as the optimal source of nourishment for infants (IOM, 1991; Gartner et al., 2005). There are no reports of any full-term, vitamin D–replete infants developing calcium deficiency when exclusively fed hu- man milk (Mimouni et al., 1993; Abrams, 2006). Therefore, AIs for calcium

OCR for page 345
349 DIETARY REFERENCE INTAKES FOR ADEQUACY TABLE 5-1 Calcium Dietary Reference Intakes (DRIs) for Adequacy (amount/day) Life Stage Group AI EAR RDA Infants 0 to 6 mo 200 mg — — 6 to 12 mo 260 mg — — Children 1–3 y — 500 mg 700 mg 4–8 y — 800 mg 1,000 mg Males 9–13 y — 1,100 mg 1,300 mg 14–18 y — 1,100 mg 1,300 mg 19–30 y — 800 mg 1,000 mg 31–50 y — 800 mg 1,000 mg 51–70 y — 800 mg 1,000 mg > 70 y — 1,000 mg 1,200 mg Females 9–13 y — 1,100 mg 1,300 mg 14–18 y — 1,100 mg 1,300 mg 19–30 y — 800 mg 1,000 mg 31–50 y — 800 mg 1,000 mg 51–70 y — 1,000 mg 1,200 mg > 70 y — 1,000 mg 1,200 mg Pregnancy 14–18 y — 1,100 mg 1,300 mg 19–30 y — 800 mg 1,000 mg 31–50 y — 800 mg 1,000 mg Lactation 14–18 y — 1,100 mg 1,300 mg 19–30 y — 800 mg 1,000 mg 31–50 y — 800 mg 1,000 mg NOTE: AI = Adequate Intake; EAR = Estimated Average Requirement; RDA = Recommended Dietary Allowance. for infants are based on mean intake data from infants fed human milk as the principal fluid during the first year of life and on the studies that have determined the mean calcium content of breast milk. Additionally, infor- mation on calcium absorption and calcium accretion is taken into account. With respect to estimating AIs for calcium for infants, studies reviewed previously in this report have provided the following information: • Based on infant weighing studies, a reasonable average amount of breast milk consumed is 780 mL/day. The average level of calcium within a liter of breast milk is 259 mg (± 59 mg). It is therefore estimated that the intake of calcium for infants fed exclusively hu- man milk is 202 mg/day. This number is rounded to 200 mg/day.

OCR for page 345
350 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D • Calcium absorption for this age group ranges somewhat above and below 60 percent depending upon the total amount of calcium consumed. For development of the AI, a 60 percent calcium ab- sorption rate was assumed. • The usual accretion rate for calcium in infants can be estimated us- ing the approximation of 100 mg/day overall during the first year of life, with the recognition that the available literature contains reports of varying rates above and below that level. Infants 0 to 6 Months of Age Using the estimates described above for the calcium content of breast milk and the amount of milk consumed per day, the AI for calcium for in- fants 0 to 6 months of age is 200 mg/day, a value reflective of the calcium provided to exclusively breast-fed infants. The expected net retention of calcium from human milk assuming 60 percent absorption would be 120 mg/day, which is in excess of the values predicted from calcium accre- tion based on cadaver and metacarpal analysis. An AI of 200 mg/day is expected, therefore, to result in retention of sufficient amounts of calcium to meet growth needs. Further, for infants in the first 4 months of life, balance studies suggest that 40 to 70 percent of the daily calcium intake is retained by the human milk-fed infant (Widdowson, 1965; Fomon and Nelson, 1993). In balance studies using human milk–fed infants, the mean calcium intake was 327 mg/day, and calcium retention was 172 mg/day on average (Fomon and Nelson, 1993). If infants consume calcium at the AI daily, they would achieve similar or greater calcium retention even if the efficiency of absorp- tion was at the lower observed value of 30 percent. Thus, the AI should meet most infants’ needs. The AI established here of 200 mg/day is similar to the AI of 210 mg/ day derived by the 1997 report (IOM, 1997). The difference is extremely small—only 10 mg/day—and likely within measurement error; however, the new AI reflects the current best estimate for calcium levels obtained exclusively from human milk Infants 6 to 12 Months of Age Estimation of the AI for infants 6 to 12 months of age takes into ac- count the additional intake of calcium from food. From 6 to 12 months of age, the intake of solid foods becomes more significant, and calcium in- takes may increase substantially from these sources. Only extremely limited data are available for typical calcium intakes from foods by older milk-fed infants, and mean calcium intake from solid foods has been approxi-

OCR for page 345
351 DIETARY REFERENCE INTAKES FOR ADEQUACY mated as 140 mg/day for formula-fed infants (personal communication, Dr. Steven Abrams, February 22, 2010). For the purpose of developing an AI for this age group, it is assumed that infants who are fed human milk have intakes of solid food similar to those of formula-fed infants of the same age (Specker et al., 1997). Based on data from Dewey et al. (1984), mean human milk intake during the second 6 months of life would be 600 mL/day. Thus, calcium intake from human milk with a calcium concentration of about 200 mg/L during this age span (Atkinson et al., 1995) would be approximately 120 mg/day. Add- ing the estimated intake from food (140 mg/day) to the estimated intake from human milk (120 mg/day) gives a total intake of 260 mg/day. Again, this AI is slightly and probably insignificantly less than the 1997 AI (IOM, 1997) but is the current best estimate. Children and Adolescents 1 Through 18 Years of Age Children 1 Through 3 Years of Age EAR 500 mg/day Calcium RDA 700 mg/day Calcium Children 4 Through 8 Years of Age EAR 800 mg/day Calcium RDA 1,000 mg/day Calcium Children 9 Through 13 Years of Age Adolescents 14 Through 18 Years of Age EAR 1,100 mg/day Calcium RDA 1,300 mg/day Calcium For these life stage groups, the focus is the level of calcium intake consistent with bone accretion and positive calcium balance. Studies con- ducted primarily between 1999 and 2009 (see Table 5-2) provide a basis for estimating EARs and calculating RDAs. In contrast to earlier reference value deliberations for which there were virtually no available studies fo- cused on children and adolescents, this committee benefited from several recent studies that used children as subjects. The approach used for children was to determine average calcium accretion through bone measures such as DXA and average calcium reten- tion as estimated by calcium balance studies (i.e., positive balance). Next, the factorial method (IOM, 1997) was used with these two data sets to estimate the intake needed to achieve the bone accretion. Average bone calcium accretion is used rather than peak calcium accretion because the committee judged this value to be more consistent with meeting the needs

OCR for page 345
352 TABLE 5-2 Calcium Intake Estimated to Achieve Average Bone Calcium Accretion for Children and Adolescents Using the Factorial Method Average Estimated Calcium Urinary Endogenous Total Total Intake Age/ Accretion Losses Fecal Calcium Sweat Losses Needed Absorption (Adjusted for Study Author, Year Gender (mg/day) (mg/day) Losses (mg/day) (mg/day) (mg/day) (percent) Absorption) Lynch et al., 2007 1–3 Male/Female 142 34 40 — 216 45.6 474 Abrams et al., 1999; 4–8 Male/Female 140–160 40 50 — 240 30.0 800 Ames et al., 1999 Vatanparast et al., 2010 9–13 Female 151 106 112 55 424 38.0 1,116 9–13 Male 141 127 108 55 465 38.0 1,224 14–18 Female 92 106 112 55 365 38.0 961 14–18 Male 210 127 105 55 500 38.0 1,316 9–18 Female 121 106 112 55 394 38.0 1,037 9–18 Male 175 127 108 55 465 38.0 1,224

OCR for page 345
353 DIETARY REFERENCE INTAKES FOR ADEQUACY of 50 percent of this population, and hence an EAR (rather than an AI). Moreover, as discussed in Chapter 2, peak calcium accretion with higher total calcium intakes is likely transitory and, thus, not consistent with DRI development. The application of the factorial method using average bone calcium accretion allows an estimate of the calcium intake required to support bone accretion and net calcium retention, as shown in Table 5-2. The ap- proach is described below, specifically for each life stage for children and adolescents. Children 1 Through 3 Years of Age The data are very limited for children 1 through 3 years of age given the challenges in studying young children. However, a report by Lynch et al. (2007) provides relevant data. Linear and non-linear modeling in this study suggested a target average calcium retention level of 142 mg/ day, consistent with the growth needs of this life stage group. Through the factorial method, a calcium intake of 474 mg/day is estimated to meet this need (see Table 5-2). Given that these data are derived from mean esti- mates and are assumed to be normally distributed, the mean value is very likely the median value. An estimated EAR is, therefore, established as 500 mg of calcium per day, rounded from 474 mg/day. An assumption specified by Lynch et al. (2007) is that an additional 30 percent calcium retention would meet the needs of 97.5 percent of this age group. This was calculated as 180 mg/day and is based on calcium absorp- tive efficiency for young children, and it is judged reasonable. This results in an estimated RDA for calcium of 700 mg/day calcium, with rounding. Clearly, there are uncertainties when reliance is placed on a single study. The ability to study calcium requirements in a controlled study, however, does offer the ability to estimate an average requirement rather than an AI. The study is of high quality, and the reference values specified are in line with those specified for younger and older children. Children 4 Through 8 Years of Age The work of Abrams et al. (1999) and Ames et al. (1999) has indicated that, like that for younger children, an average calcium retention level of approximately 140 mg/day is consistent with the needs of bone accre- tion. However, there is evidence of a small increase during pre-puberty, yielding a calcium retention range of approximately 140 to 160 mg/day to allow for bone accretion across this age group of which a portion will be pre-pubertal. Using the factorial method (see Table 5-2) and from the non-linear dose–response relationship identified by the work of Ames

OCR for page 345
354 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D et al.(1999) and Abrams et al. (1999), a calcium intake of 800 mg/day could be expected to achieve the levels of calcium needed for bone ac- cretion. Again, the assumption that another approximately 30 percent is needed to cover about 97.5 percent of the population—through derivation as mean estimates and the assumption of normal distribution—results in a calculated and rounded RDA value for calcium of 1,000 mg/day. Again, as with younger children, there are relatively few studies avail- able and most have small sample sizes. While the studies included some ethnic/racial diversity, they focused on girls. These limitations cannot be remedied at this time. However, the data are sufficiently robust to support an estimation of an average requirement of 800 mg/day calcium. Children 9 Through 13 Years of Age and Adolescents 14 Through 18 Years of Age As reviewed in Chapter 4, data from a recent study (Vatanparast et al., 2010) have provided bone calcium accretion levels for children and adoles- cents ranging from 92 to 210 mg/day. Average bone calcium accretion was included in the factorial method, and the intake levels can be estimated as shown in Table 5-2. While the committee was aware of data suggesting that calcium re- tention may vary by gender among children, these differences between girls and boys and between the 9- to 13- and 14- to 18-year age groups are relatively small quantitatively, and the limited nature of the data do not allow further specification of these differences to the extent they are real. Given the application of DRI values in real world settings such as school meal planning, recommending that boys receive a small amount more calcium than girls is not practicable, but it is also not warranted given the limited nature of the data suggesting this possibility. Additionally, there is wide variability in the onset of puberty and the pubertal growth spurt, and it is reasonable to conclude that increases in calcium intake may be needed early in puberty at times when children may be only 9 or 10 years old. Thus, for reference values for both boys and girls in the 9- to 13- and 14- to 18-year life stages, the differences in calcium intake to achieve mean bone calcium accretion as elucidated by Vatanparast et al. (2010) have been interpolated between 9- to 18-year old girls (1,037) and boys (1,224). This interpolation yields an estimated mean need for calcium for boys and girls of 1,100 mg/day with rounding, a value approximately at the midpoint between the two groups. Again, assuming a normal distribution, this estimate to achieve a mean calcium accretion represents the median and, thus, an EAR. The EAR is therefore set at 1,100 mg for both boys and girls for both life stages encompassed by the 9 through 18 year age range. In order to cover 97.5 percent of the population, an estimated RDA value for calcium of 1,300 mg/day is established.

OCR for page 345
355 DIETARY REFERENCE INTAKES FOR ADEQUACY The uncertainties surrounding the reference value stem from reli- ance on primarily a single study. Although carefully carried out, the study included only white children. These newer data, however, provide the op- portunity to identify an average requirement. Adults 19 Through 50 Years of Age Adults 19 Through 30 Years of Age Adults 31 Through 50 Years of Age EAR 800 mg/day Calcium RDA 1,000 mg/day Calcium While there is evidence of minor bone accretion into early adulthood, the levels required to achieve this accretion—which appears to be site dependent—are very low. The goal, therefore, is intakes of calcium that promote bone maintenance and neutral calcium balance. The report from Hunt and Johnson (2007) provides virtually the only evidence for these life stage groups. Based on a series of controlled calcium balance studies, they have established a calcium intake level of 741 mg/day to maintain neutral calcium balance. They further provide the 95 percent prediction interval around the level required for neutral calcium balance. Other available measures that relate to bone maintenance include bone mineral density (BMD), but studies that measured bone mass con- comitant to calcium intake are highly confounded by failures to control for other variables that impact bone mass and to specify a dose–response relationship. There is no evidence that intakes of calcium higher than those specified by Hunt and Johnson (2007) offer benefit for bone health in the context of bone maintenance for adults 19 to 50 years of age. Os- teoporotic fracture is not a relevant measure for this life stage, therefore extrapolating from the more prevalent data focused on older adults is not appropriate, nor is extrapolating from the data for younger persons for whom the concern is bone accretion. Therefore, the Hunt and Johnson (2007) data, which reflect the out- comes of a series of metabolic studies, provide a reasonable basis for an EAR for calcium of 800 mg/day calcium. That is, the observed value of 741 mg/day is rounded, but rounded up to 800 mg/day given the uncertainty. The upper limit of the 95 percent prediction interval around this estimate (1,035 mg/day) is appropriate as the basis for an RDA for calcium and rounded to 1,000 mg/day. As is the case with younger life stage groups, there is now the 2007 Hunt and Johnson study on the topic of calcium and bone health, which has allowed the estimation of an average requirement.

OCR for page 345
392 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D RDA for persons more than 70 years of age would be higher due to this variability. In addition, there is insufficient evidence to provide assurances that 600 IU/day vitamin D is as effective as 800 IU/day. By comparing the projected RDA based on the simulation analysis (600 IU/day) with the available evidence indicating benefit at 800 IU of vitamin D per day, taking into account the uncertainties would result in an estimation of an RDA of approximately one-third higher than the simulation analysis suggests. Over- all, this is a small increase that is not known to increase the possibility of adverse events while providing a certain level of caution for this particularly vulnerable and potentially frail segment of the population. This approach is predicated on caution in the face of uncertainties, and it is anticipated that newer data in the future will help to clarify the uncertainties surround- ing the level of intake of vitamin D that could be expected to cover 97.5 percent of persons over the age of 70 years. The EAR of 400 IU/day and RDA of 800 IU/day for this life stage group, consistent with the DRIs for other life stage groups, assume minimal sun exposure. Adults 51 Through 70 Years of Age A question in establishing an EAR and RDA for this life stage group is the relevance of vitamin D in affecting bone loss due to the onset of menopause. Men in this life stage group have not yet reached the levels of bone loss and fracture rates associated with aging as manifested in persons more than 70 years of age and, unlike their female counterparts, they are not experiencing significant bone loss due to menopause. However, a portion—in fact perhaps the majority—of women in this life stage group are likely to be experiencing some degree of bone loss due to menopause. As discussed above for adults more than 70 years of age, the available data do not suggest that median requirements increase with aging, result- ing in support for an EAR of 400 IU/day, the same as for younger adults. Likewise, the EAR for both women and men in the 51 through 70 year life stage group is set at 400 IU of vitamin D per day. With respect to women 51 through 70 years of age, fracture risk is lower than it is later in life; and as such, it is not entirely congruent with the situation for adults more than 70 years of age. Further, findings for this age group are at best mixed, but are generally not supportive of an effect of vitamin D alone on bone health. Although the AHRQ analyses of studies using vitamin D alone found the results to be inconsistent for a relationship with reduction in fracture risk, more recent studies have trended toward no significant effects (Bunout et al., 2006; Burleigh et al., 2007; Lyons et al., 2007; Avenell et al., 2009b). For those studies showing benefit for BMD with a vitamin D and calcium combination, interpretation

OCR for page 345
393 DIETARY REFERENCE INTAKES FOR ADEQUACY is confounded by the effects of calcium especially since calcium alone ap- pears to have at least a modest effect on BMD. The report from the WHI (Jackson et al., 2006), a very large cohort study, has limited applicability to the question of the effect of vitamin D on bone health among women because of relatively high levels of calcium intake (baseline mean calcium intake of approximately 1,150 mg/day at randomization plus 1,000 mg/day supplement) and the confounding due to hormone replacement therapy. Given these data plus the inability to extrapolate the variability seen in the requirements surrounding persons 70 or more years of age to this life stage group, the RDA for women 51 through 70 years of age is set at 600 IU of vitamin D per day, the same level as that for younger adults. With respect to men 51 through 70 years of age, there is also no basis to deviate from the RDA set for younger adults. The available evidence for men is extremely limited, and there are not data to suggest that bone health is enhanced by vitamin D intake among men in this life stage group. An RDA of 600 IU/ day is established for these men. The DRIs for these two life stage groups assume minimal sun exposure. Pregnancy and Lactation Pregnant 14 Through 18 Years of Age Pregnant 19 Through 30 Years of Age Pregnant 31 Through 50 Years of Age EAR 400 IU (10 µg)/day Vitamin D RDA 600 IU (15 µg)/day Vitamin D Lactating 14 Through 18 Years of Age Lactating 19 Through 30 Years of Age Lactating 31 Through 50 Years of Age EAR 400 IU (10 µg)/day Vitamin D RDA 600 IU (15 µg)/day Vitamin D Pregnancy The EAR for non-pregnant women and adolescents is appro- priate for pregnant women and adolescents based on: (1) AHRQ-Ottawa’s finding of insufficient evidence on the association of serum 25OHD level with maternal BMD during pregnancy and (2) the 1 available RCT (Delvin et al., 1986) and 14 observational studies reviewed in Chapter 4 regarding vitamin D deficiency and genetic absence of the vitamin D receptor (VDR) or 1α-hydroxyalase, which all demonstrate no effect of maternal 25OHD level on fetal calcium homeostasis or skeletal outcomes. Of the limited number (i.e., four) of observational studies that suggest an influence of maternal serum 25OHD levels on the offspring’s skeletal outcomes later in life (so-called developmental programming), one study reports associa-

OCR for page 345
394 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D tions consistent with an EAR-type value of approximately 40 nmol/L below which negative fetal skeletal outcomes were reported (Viljakainen et al., 2010), and another reports an RDA-type value of 50 nmol/L late in gesta- tion above which reduced skeletal BMC was not seen in offspring at 9 years of age (Javaid et al., 2006). In addition, development of the fetal skeleton without dependence on maternal vitamin D is also biologically plausible as indicated by the studies in animal models in rats, mice, pigs, and sheep (see review in Chapter 3). Finally, there is no evidence that the vitamin D requirements of pregnant adolescents differ from those of non-pregnant adolescents. The EAR is thus 400 IU of vitamin D per day for pregnant women and adolescents. Likewise, the RDA values for non-pregnant women and ado- lescents are applicable, providing an RDA of 600 IU/day for each group. Lactation The EAR for non-lactating women and adolescents is ap- propriate for lactating women and adolescents based on evidence from RCTs (Rothberg et al., 1982; Ala-Houhala, 1985; Ala-Houhala et al., 1988; Kalkwarf et al., 1996; Hollis and Wagner, 2004; Basile et al., 2006; Wagner et al., 2006; Saadi et al., 2007), which are consistent with observational data (Cancela et al., 1986; Okonofua et al., 1987; Takeuchi et al., 1989; Kent et al., 1990; Alfaham et al., 1995; Sowers et al., 1998) that increased maternal vitamin D intakes increase maternal serum 25OHD levels, with no effect on the neonatal serum 25OHD levels of breast-fed infants unless the maternal intake of vitamin D is extremely high (i.e., 4,000 to 6,400 IU/ day) (Wagner et al., 2006). Observational studies report no relationship between maternal serum 25OHD levels and BMD (Ghannam et al., 1999) or breast milk calcium content (Prentice et al., 1997). Also, there is no evidence that lactating adolescents require any more vitamin D or higher serum 25OHD levels than non-lactating adolescents. The EAR is thus 400 IU of vitamin D per day for lactating women and adolescents. Likewise, the RDA values for non-lactating women and adolescents are applicable, providing an RDA of 600 IU/day for each group. REFERENCES Abrams, S. A., K. C. Copeland, S. K. Gunn, J. E. Stuff, L. L. Clarke and K. J. Ellis. 1999. Calcium absorption and kinetics are similar in 7- and 8-year-old Mexican-American and Caucasian girls despite hormonal differences. Journal of Nutrition 129(3): 666-71. Abrams, S. A. 2006. Building bones in babies: can and should we exceed the human milk-fed infant’s rate of bone calcium accretion? Nutrition Reviews 64(11): 487-94. Abrams, S. A., P. D. Hicks and K. M. Hawthorne. 2009. Higher serum 25-hydroxyvitamin D levels in school-age children are inconsistently associated with increased calcium absorp- tion. Journal of Clinical Endocrinology and Metabolism 94(7): 2421-7.

OCR for page 345
395 DIETARY REFERENCE INTAKES FOR ADEQUACY Ala-Houhala, M. 1985. 25-hydroxyvitamin D levels during breast-feeding with or without ma- ternal or infantile supplementation of vitamin D. Journal of Pediatric Gastroenterology and Nutrition 4(2): 220-6. Ala-Houhala, M., T. Koskinen, M. Koskinen and J. K. Visakorpi. 1988. Double blind study on the need for vitamin D supplementation in prepubertal children. Acta Paediatrica Scandinavica 77(1): 89-93. Alevizaki, C. C., D. G. Ikkos and P. Singhelakis. 1973. Progressive decrease of true intestinal calcium absorption with age in normal man. Journal of Nuclear Medicine 14(10): 760-2. Alfaham, M., S. Woodhead, G. Pask and D. Davies. 1995. Vitamin D deficiency: a concern in pregnant Asian women. British Journal of Nutrition 73(6): 881-7. Ambroszkiewicz, J., W. Klemarczyk, J. Gajewska, M. Chelchowska and T. Laskowska-Klita. 2007. Serum concentration of biochemical bone turnover markers in vegetarian children. Advances in Medical Science 52: 279-82. Ames, S. K., B. M. Gorham and S. A. Abrams. 1999. Effects of high compared with low cal- cium intake on calcium absorption and incorporation of iron by red blood cells in small children. American Journal of Clinical Nutrition 70(1): 44-8. Andersen, R., C. Molgaard, L. T. Skovgaard, C. Brot, K. D. Cashman, E. Chabros, J. Charzewska, A. Flynn, J. Jakobsen, M. Karkkainen, M. Kiely, C. Lamberg-Allardt, O. Moreiras, A. M. Natri, M. O’Brien, M. Rogalska-Niedzwiedz and L. Ovesen. 2005. Teenage girls and elderly women living in northern Europe have low winter vitamin D status. European Journal of Clinical Nutrition 59(4): 533-41. Anderson, P. H., R. K. Sawyer, A. J. Moore, B. K. May, P. D. O’Loughlin and H. A. Morris. 2008. Vitamin D depletion induces RANKL-mediated osteoclastogenesis and bone loss in a rodent model. Journal of Bone and Mineral Research 23(11): 1789-97. Atkinson, S. A., B. P. Alston-Mills, B. Lonnerdal, M. C. Neville and M. P. Thompson. 1995. Major minerals and ionic constituents of human and bovine milk. In Handbook of Milk Composition, edited by R. J. Jensen. San Diego, CA: Academic Press. Pp. 593-619. Avenell, A. and H. H. Handoll. 2004. Nutritional supplementation for hip fracture aftercare in the elderly. Cochrane Database System Review (1): CD001880. Avenell, A., W. J. Gillespie, L. D. Gillespie and D. O’Connell. 2009. Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis. Cochrane Database System Review (2): CD000227. Avioli, L. V., J. E. McDonald and S. W. Lee. 1965. The influence of age on the intestinal absorption of 47-Ca absorption in post-menopausal osteoporosis. Journal of Clinical Investigation 44(12): 1960-7. Basile, L. A., S. N. Taylor, C. L. Wagner, R. L. Horst and B. W. Hollis. 2006. The effect of high-dose vitamin D supplementation on serum vitamin D levels and milk calcium con- centration in lactating women and their infants. Breastfeeding Medicine 1(1): 27-35. Bergink, A. P., A. G. Uitterlinden, J. P. Van Leeuwen, C. J. Buurman, A. Hofman, J. A. Verhaar and H. A. Pols. 2009. Vitamin D status, bone mineral density, and the development of radiographic osteoarthritis of the knee: The Rotterdam Study. Journal of Clinical Rheu- matology 15(5): 230-7. Biancuzzo, R. M., A. Young, D. Bibuld, M. H. Cai, M. R. Winter, E. K. Klein, A. Ameri, R. Reitz, W. Salameh, T. C. Chen and M. F. Holick. 2010. Fortification of orange juice with vitamin D(2) or vitamin D(3) is as effective as an oral supplement in maintaining vitamin D status in adults. American Journal of Clinical Nutrition 91(6): 1621-6. Brannon, P. M., E. A. Yetley, R. L. Bailey and M. F. Picciano. 2008. Vitamin D and health in the 21st century: an update. Proceedings of a conference held September 2007 in Bethesda, Maryland, USA. American Journal of Clinical Nutrition 88(2): 483S-592S. Bullamore, J. R., R. Wilkinson, J. C. Gallagher, B. E. Nordin and D. H. Marshall. 1970. Effect of age on calcium absorption. Lancet 2(7672): 535-7.

OCR for page 345
396 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D Bunout, D., G. Barrera, L. Leiva, V. Gattas, M. P. de la Maza, M. Avendano and S. Hirsch. 2006. Effects of vitamin D supplementation and exercise training on physical performance in Chilean vitamin D deficient elderly subjects. Experimental Gerontology 41(8): 746-52. Burleigh, E., J. McColl and J. Potter. 2007. Does vitamin D stop inpatients falling? A ran- domised controlled trial. Age Ageing 36(5): 507-13. Cancela, L., N. Le Boulch and L. Miravet. 1986. Relationship between the vitamin D content of maternal milk and the vitamin D status of nursing women and breast-fed infants. Journal of Endocrinology 110(1): 43-50. Carter, G. D., J. L. Berry, E. Gunter, G. Jones, J. C. Jones, H. L. Makin, S. Sufi and M. J. Wheeler. 2010. Proficiency testing of 25-hydroxyvitamin D (25-OHD) assays. Journal of Steroid Biochemistry and Molecular Biology 121(1-2): 176-9. Cashman, K. D., T. R. Hill, A. J. Lucey, N. Taylor, K. M. Seamans, S. Muldowney, A. P. Fitzgerald, A. Flynn, M. S. Barnes, G. Horigan, M. P. Bonham, E. M. Duffy, J. J. Strain, J. M. Wallace and M. Kiely. 2008. Estimation of the dietary requirement for vitamin D in healthy adults. American Journal of Clinical Nutrition 88(6): 1535-42. Cashman, K. D., J. M. Wallace, G. Horigan, T. R. Hill, M. S. Barnes, A. J. Lucey, M. P. Bonham, N. Taylor, E. M. Duffy, K. Seamans, S. Muldowney, A. P. Fitzgerald, A. Flynn, J. J. Strain and M. Kiely. 2009. Estimation of the dietary requirement for vitamin D in free-living adults ≥64 y of age. American Journal of Clinical Nutrition 89(5): 1366-74. Cauley, J. A., A. Z. Lacroix, L. Wu, M. Horwitz, M. E. Danielson, D. C. Bauer, J. S. Lee, R. D. Jackson, J. A. Robbins, C. Wu, F. Z. Stanczyk, M. S. LeBoff, J. Wactawski-Wende, G. Sarto, J. Ockene and S. R. Cummings. 2008. Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Annals of Internal Medicine 149(4): 242-50. Cauley, J. A., N. Parimi, K. E. Ensrud, D. C. Bauer, P. M. Cawthon, S. R. Cummings, A. R. Hoff- man, J. M. Shikany, E. Barrett-Connor and E. Orwoll. 2010. Serum 25 hydroxyvitamin D and the risk of hip and non-spine fractures in older men. Journal of Bone and Mineral Research 25(3): 545. Chantry, C. J., P. Auinger and R. S. Byrd. 2004. Lactation among adolescent mothers and sub- sequent bone mineral density. Archives of Pediatrics and Adolescent Medicine 158(7): 650-6. Chapuy, M. C., M. E. Arlot, F. Duboeuf, J. Brun, B. Crouzet, S. Arnaud, P. D. Delmas and P. J. Meunier. 1992. Vitamin D3 and calcium to prevent hip fractures in the elderly women. New England Journal of Medicine 327(23): 1637-42. Chung M., E. M. Balk, M. Brendel, S. Ip, J. Lau, J. Lee, A. Lichtenstein, K. Patel, G. Raman, A. Tatsioni, T. Terasawa and T. A. Trikalinos. 2009. Vitamin D and calcium: a systematic review of health outcomes. Evidence Report No. 183. (Prepared by the Tufts Evidence- based Practice Center under Contract No. HHSA 290-2007-10055-I.) AHRQ Publication No. 09-E015. Rockville, MD: Agency for Healthcare Research and Quality. Cranney A., T. Horsley, S. O’Donnell, H. A. Weiler, L. Puil, D. S. Ooi, S. A. Atkinson, L. M. Ward, D. Moher, D. A. Hanley, M. Fang, F. Yazdi, C. Garritty, M. Sampson, N. Barrowman, A. Tsertsvadze and V. Mamaladze. 2007. Effectiveness and safety of vitamin D in relation to bone health. Evidence Report/Technology Assessment No. 158. (Pre- pared by the University of Ottawa Evidence-based Practice Center (UO-EPC) under Contract No. 290-02-0021.) AHRQ Publication No. 07-E013. Rockville, MD: Agency for Healthcare Research and Quality. Cross, N. A., L. S. Hillman, S. H. Allen, G. F. Krause and N. E. Vieira. 1995. Calcium homeo- stasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. American Journal of Clinical Nutrition 61(3): 514-23. Dawson-Hughes, B., G. E. Dallal, E. A. Krall, S. Harris, L. J. Sokoll and G. Falconer. 1991. Effect of vitamin D supplementation on wintertime and overall bone loss in healthy postmenopausal women. Annals of Internal Medicine 115(7): 505-12.

OCR for page 345
397 DIETARY REFERENCE INTAKES FOR ADEQUACY Delvin, E. E., B. L. Salle, F. H. Glorieux, P. Adeleine and L. S. David. 1986. Vitamin D supplementation during pregnancy: effect on neonatal calcium homeostasis. Journal of Pediatrics 109(2): 328-34. Dewey, K. G., D. A. Finley and B. Lonnerdal. 1984. Breast milk volume and composition dur- ing late lactation (7-20 months). Journal of Pediatric Gastroenterology and Nutrition 3(5): 713-20. Ensrud, K. E., B. C. Taylor, M. L. Paudel, J. A. Cauley, P. M. Cawthon, S. R. Cummings, H. A. Fink, E. Barrett-Connor, J. M. Zmuda, J. M. Shikany and E. S. Orwoll. 2009. Serum 25-hydroxyvitamin D levels and rate of hip bone loss in older men. Journal of Clinical Endocrinology and Metabolism 94(8): 2773-80. Fairweather-Tait, S., A. Prentice, K. G. Heumann, L. M. Jarjou, D. M. Stirling, S. G. Wharf and J. R. Turnlund. 1995. Effect of calcium supplements and stage of lactation on the calcium absorption efficiency of lactating women accustomed to low calcium intakes. American Journal of Clinical Nutrition 62(6): 1188-92. Fleet, J. C., C. Gliniak, Z. Zhang, Y. Xue, K. B. Smith, R. McCreedy and S. A. Adedokun. 2008. Serum metabolite profiles and target tissue gene expression define the effect of cholecalciferol intake on calcium metabolism in rats and mice. Journal of Nutrition 138(6): 1114-20. Fomon, S. J. and S. E. Nelson. 1993. Calcium, phosphorus, magnesium, and sulfur. In Nu- trition of Normal Infants, edited by S. J. Fomon. St. Louis: Mosby-Year Book, Inc. Pp. 192-216. Gallagher, J. C., B. L. Riggs, J. Eisman, A. Hamstra, S. B. Arnaud and H. F. DeLuca. 1979. Intestinal calcium absorption and serum vitamin D metabolites in normal subjects and osteoporotic patients: effect of age and dietary calcium. Journal of Clinical Investigation 64(3): 729-36. Gartner, L. M., J. Morton, R. A. Lawrence, A. J. Naylor, D. O’Hare, R. J. Schanler and A. I. Eidelman. 2005. Breastfeeding and the use of human milk. Pediatrics 115(2): 496-506. Ghannam, N. N., M. M. Hammami, S. M. Bakheet and B. A. Khan. 1999. Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation. Calcified Tissue International 65(1): 23-8. Grant, A. M., A. Avenell, M. K. Campbell, A. M. McDonald, G. S. MacLennan, G. C. McPherson, F. H. Anderson, C. Cooper, R. M. Francis, C. Donaldson, W. J. Gillespie, C. M. Robinson, D. J. Torgerson and W. A. Wallace. 2005. Oral vitamin D3 and calcium for secondary pre- vention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 365(9471): 1621-8. Greer, F. R., J. E. Searcy, R. S. Levin, J. J. Steichen, P. S. Steichen-Asche and R. C. Tsang. 1982. Bone mineral content and serum 25-hydroxyvitamin D concentrations in breast- fed infants with and without supplemental vitamin D: one-year follow-up. Journal of Pediatrics 100(6): 919-22. Greer, F. R. and S. Marshall. 1989. Bone mineral content, serum vitamin D metabolite con- centrations, and ultraviolet B light exposure in infants fed human milk with and without vitamin D2 supplements. Journal of Pediatrics 114(2): 204-12. Harris, S. S. and B. Dawson-Hughes. 2002. Plasma vitamin D and 25OHD responses of young and old men to supplementation with vitamin D3. Journal of the American College of Nutrition 21(4): 357-62. Harwood, R. H., O. Sahota, K. Gaynor, T. Masud and D. J. Hosking. 2004. A randomised, controlled comparison of different calcium and vitamin D supplementation regimens in elderly women after hip fracture: The Nottingham Neck of Femur (NONOF) Study. Age and Ageing 33(1): 45-51.

OCR for page 345
398 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D Heaney, R. P., K. M. Davies, T. C. Chen, M. F. Holick and M. J. Barger-Lux. 2003. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. American Journal of Clinical Nutrition 77(1): 204-10. Holick, M. F., R. M. Biancuzzo, T. C. Chen, E. K. Klein, A. Young, D. Bibuld, R. Reitz, W. Salameh, A. Ameri and A. D. Tannenbaum. 2008. Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. Journal of Clinical Endocrinology and Metabolism 93(3): 677-81. Hollis, B. W. and C. L. Wagner. 2004. Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. American Journal of Clinical Nutrition 80(Suppl 6): 1752S-8S. Honkanen, R., E. Alhava, M. Parviainen, S. Talasniemi and R. Monkkonen. 1990. The neces- sity and safety of calcium and vitamin D in the elderly. Journal of the American Geriatrics Society 38(8): 862-6. Hunt, C. D. and L. K. Johnson. 2007. Calcium requirements: new estimations for men and women by cross–sectional statistical analyses of calcium balance data from metabolic studies. American Journal of Clinical Nutrition 86(4): 1054-63. IOM (Institute of Medicine). 1991. Nutrition During Lactation. Washington, DC: National Academy Press. IOM. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academy Press. Jackson, R. D., A. Z. LaCroix, M. Gass, R. B. Wallace, J. Robbins, C. E. Lewis, T. Bassford, S. A. Beresford, H. R. Black, P. Blanchette, D. E. Bonds, R. L. Brunner, R. G. Brzyski, B. Caan, J. A. Cauley, R. T. Chlebowski, S. R. Cummings, I. Granek, J. Hays, G. Heiss, S. L. Hendrix, B. V. Howard, J. Hsia, F. A. Hubbell, K. C. Johnson, H. Judd, J. M. Kotchen, L. H. Kuller, R. D. Langer, N. L. Lasser, M. C. Limacher, S. Ludlam, J. E. Manson, K. L. Margolis, J. McGowan, J. K. Ockene, M. J. O’Sullivan, L. Phillips, R. L. Prentice, G. E. Sarto, M. L. Stefanick, L. Van Horn, J. Wactawski-Wende, E. Whitlock, G. L. Anderson, A. R. Assaf and D. Barad. 2006. Calcium plus vitamin D supplementation and the risk of fractures. New England Journal of Medicine 354(7): 669-83. Jarjou, L. M., A. Prentice, Y. Sawo, M. A. Laskey, J. Bennett, G. R. Goldberg and T. J. Cole. 2006. Randomized, placebo-controlled, calcium supplementation study in pregnant Gambian women: effects on breast-milk calcium concentrations and infant birth weight, growth, and bone mineral accretion in the first year of life. American Journal of Clinical Nutrition 83(3): 657-66. Jarjou, L. M., M. A. Laskey, Y. Sawo, G. R. Goldberg, T. J. Cole and A. Prentice. 2010. Effect of calcium supplementation in pregnancy on maternal bone outcomes in women with a low calcium intake. American Journal of Clinical Nutrition 92(2): 450-7. Javaid, M. K., S. R. Crozier, N. C. Harvey, C. R. Gale, E. M. Dennison, B. J. Boucher, N. K. Arden, K. M. Godfrey and C. Cooper. 2006. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 367(9504): 36-43. Kalkwarf, H. J., B. L. Specker, J. E. Heubi, N. E. Vieira and A. L. Yergey. 1996. Intestinal calcium absorption of women during lactation and after weaning. American Journal of Clinical Nutrition 63(4): 526-31. Kalkwarf, H. J., B. L. Specker, D. C. Bianchi, J. Ranz and M. Ho. 1997. The effect of calcium supplementation on bone density during lactation and after weaning. New England Journal of Medicine 337(8): 523-8. Kalkwarf, H. J. 1999. Hormonal and dietary regulation of changes in bone density during lac- tation and after weaning in women. Journal of Mammary Gland Biology and Neoplasia 4(3): 319-29.

OCR for page 345
399 DIETARY REFERENCE INTAKES FOR ADEQUACY Kent, G. N., R. I. Price, D. H. Gutteridge, M. Smith, J. R. Allen, C. I. Bhagat, M. P. Barnes, C. J. Hickling, R. W. Retallack, S. G. Wilson and et al. 1990. Human lactation: forearm trabecular bone loss, increased bone turnover, and renal conservation of calcium and inorganic phosphate with recovery of bone mass following weaning. Journal of Bone and Mineral Research 5(4): 361-9. Khosla, S., S. Amin and E. Orwoll. 2008. Osteoporosis in men. Endocrine Reviews 29(4): 441-64. Koo, W. W., J. C. Walters, J. Esterlitz, R. J. Levine, A. J. Bush and B. Sibai. 1999. Maternal calcium supplementation and fetal bone mineralization. Obstetrics and Gynecology 94(4): 577-82. Kovacs, C. S. and H. M. Kronenberg. 1997. Maternal-fetal calcium and bone metabolism dur- ing pregnancy, puerperium, and lactation. Endocrine Reviews 18(6): 832-72. Larsen, E. R., L. Mosekilde and A. Foldspang. 2004. Vitamin D and calcium supplementation prevents osteoporotic fractures in elderly community dwelling residents: a pragmatic population-based 3-year intervention study. Journal of Bone and Mineral Research 19(3): 370-8. Laskey, M. A., A. Prentice, L. A. Hanratty, L. M. Jarjou, B. Dibba, S. R. Beavan and T. J. Cole. 1998. Bone changes after 3 mo of lactation: influence of calcium intake, breast-milk output, and vitamin D-receptor genotype. American Journal of Clinical Nutrition 67(4): 685-92. Law, M., H. Withers, J. Morris and F. Anderson. 2006. Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in resi- dential accommodation. Age and Ageing 35(5): 482-6. Li-Ng, M., J. F. Aloia, S. Pollack, B. A. Cunha, M. Mikhail, J. Yeh and N. Berbari. 2009. A ran- domized controlled trial of vitamin D3 supplementation for the prevention of symptom- atic upper respiratory tract infections. Epidemiology and Infection 137(10): 1396-404. Lips, P., W. C. Graafmans, M. E. Ooms, P. D. Bezemer and L. M. Bouter. 1996. Vitamin D supplementation and fracture incidence in elderly persons. A randomized, placebo- controlled clinical trial. Annals of Internal Medicine 124(4): 400-6. Looker, A. C. and M. E. Mussolino. 2008. Serum 25-hydroxyvitamin D and hip fracture risk in older U.S. white adults. Journal of Bone and Mineral Research 23(1): 143-50. Lynch, M. F., I. J. Griffin, K. M. Hawthorne, Z. Chen, M. Hamzo and S. A. Abrams. 2007. Cal- cium balance in 1-4-y-old children. American Journal of Clinical Nutrition 85(3): 750-4. Lyons, R. A., A. Johansen, S. Brophy, R. G. Newcombe, C. J. Phillips, B. Lervy, R. Evans, K. Wareham and M. D. Stone. 2007. Preventing fractures among older people living in in- stitutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation. Osteoporosis International 18(6): 811-8. Melhus, H., G. Snellman, R. Gedeborg, L. Byberg, L. Berglund, H. Mallmin, P. Hellman, R. Blomhoff, E. Hagstrom, J. Arnlov and K. Michaelsson. 2010. Plasma 25-hydroxyvitamin D levels and fracture risk in a community-based cohort of elderly men in Sweden. Journal of Clinical Endocrinology and Metabolism 95(6): 2637-45. Meyer, H. E., G. B. Smedshaug, E. Kvaavik, J. A. Falch, A. Tverdal and J. I. Pedersen. 2002. Can vitamin D supplementation reduce the risk of fracture in the elderly? A randomized controlled trial. Journal of Bone and Mineral Research 17(4): 709-15. Millen, A. E., J. Wactawski-Wende, M. Pettinger, M. L. Melamed, F. A. Tylavsky, S. Liu, J. Robbins, A. Z. LaCroix, M. S. LeBoff and R. D. Jackson. 2010. Predictors of serum 25- hydroxyvitamin D concentrations among postmenopausal women: the Women’s Health Initiative Calcium plus Vitamin D clinical trial. American Journal of Clinical Nutrition 91(5): 1324-35.

OCR for page 345
400 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D Mimouni, F., B. Campaigne, M. Neylan and R. C. Tsang. 1993. Bone mineralization in the first year of life in infants fed human milk, cow-milk formula, or soy-based formula. Journal of Pediatrics 122(3): 348-54. Nelson, M. L., J. M. Blum, B. W. Hollis, C. Rosen and S. S. Sullivan. 2009. Supplements of 20 microg/d cholecalciferol optimized serum 25-hydroxyvitamin D concentrations in 80% of premenopausal women in winter. Journal of Nutrition 139(3): 540-6. NOF (National Osteoporosis Foundation). 2008. Clinician’s Guide to Prevention and Treat- ment of Osteoporosis. Washington, DC: National Osteoporosis Foundation. O’Brien, K. O., M. S. Nathanson, J. Mancini and F. R. Witter. 2003. Calcium absorption is sig- nificantly higher in adolescents during pregnancy than in the early postpartum period. American Journal of Clinical Nutrition 78(6): 1188-93. Okonofua, F., R. K. Menon, S. Houlder, M. Thomas, D. Robinson, S. O’Brien and P. Dandona. 1987. Calcium, vitamin D and parathyroid hormone relationships in pregnant Caucasian and Asian women and their neonates. Annals of Clinical Biochemistry 24(Pt 1): 22-8. Orwoll, E. S., S. K. Oviatt, M. R. McClung, L. J. Deftos and G. Sexton. 1990. The rate of bone mineral loss in normal men and the effects of calcium and cholecalciferol supplementa- tion. Annals of Internal Medicine 112(1): 29-34. Peacock, M., G. Liu, M. Carey, R. McClintock, W. Ambrosius, S. Hui and C. C. Johnston. 2000. Effect of calcium or 25OH vitamin D3 dietary supplementation on bone loss at the hip in men and women over the age of 60. Journal of Clinical Endocrinology and Metabolism 85(9): 3011-9. Polatti, F., E. Capuzzo, F. Viazzo, R. Colleoni and C. Klersy. 1999. Bone mineral changes dur- ing and after lactation. Obstetrics and Gynecology 94(1): 52-6. Porthouse, J., S. Cockayne, C. King, L. Saxon, E. Steele, T. Aspray, M. Baverstock, Y. Birks, J. Dumville, R. Francis, C. Iglesias, S. Puffer, A. Sutcliffe, I. Watt and D. J. Torgerson. 2005. Randomised controlled trial of calcium and supplementation with cholecalcif- erol (vitamin D3) for prevention of fractures in primary care. British Medical Journal 330(7498): 1003. Prentice, A., L. M. Jarjou, T. J. Cole, D. M. Stirling, B. Dibba and S. Fairweather-Tait. 1995. Calcium requirements of lactating Gambian mothers: effects of a calcium supplement on breast-milk calcium concentration, maternal bone mineral content, and urinary calcium excretion. American Journal of Clinical Nutrition 62(1): 58-67. Prentice, A., L. Yan, L. M. Jarjou, B. Dibba, M. A. Laskey, D. M. Stirling and S. Fairweather- Tait. 1997. Vitamin D status does not influence the breast-milk calcium concentration of lactating mothers accustomed to a low calcium intake. Acta Paediatrica 86(9): 1006-8. Priemel, M., C. von Domarus, T. O. Klatte, S. Kessler, J. Schlie, S. Meier, N. Proksch, F. Pastor, C. Netter, T. Streichert, K. Puschel and M. Amling. 2010. Bone mineralization defects and vitamin D deficiency: histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675 patients. Journal of Bone and Mineral Research 25(2): 305-12. Prince, R. L., A. Devine, S. S. Dhaliwal and I. M. Dick. 2006. Effects of calcium supplementa- tion on clinical fracture and bone structure: results of a 5-year, double-blind, placebo- controlled trial in elderly women. Archives of Internal Medicine 166(8): 869-75. Rajakumar, K., J. D. Fernstrom, M. F. Holick, J. E. Janosky and S. L. Greenspan. 2008. Vitamin D status and response to Vitamin D(3) in obese vs. non-obese African American chil- dren. Obesity (Silver Spring) 16(1): 90-5. Rothberg, A. D., J. M. Pettifor, D. F. Cohen, E. W. Sonnendecker and F. P. Ross. 1982. Maternal-infant vitamin D relationships during breast-feeding. Journal of Pediatrics 101(4): 500-3.

OCR for page 345
401 DIETARY REFERENCE INTAKES FOR ADEQUACY Saadi, H. F., A. Dawodu, B. O. Afandi, R. Zayed, S. Benedict and N. Nagelkerke. 2007. Efficacy of daily and monthly high-dose calciferol in vitamin D-deficient nulliparous and lactating women. American Journal of Clinical Nutrition 85(6): 1565-71. Sanders, K. M., A. L. Stuart, E. J. Williamson, J. A. Simpson, M. A. Kotowicz, D. Young and G. C. Nicholson. 2010. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. Journal of the American Medical Association 303(18): 1815-22. Schou, A. J., C. Heuck and O. D. Wolthers. 2003. A randomized, controlled lower leg growth study of vitamin D supplementation to healthy children during the winter season. Annals of Human Biology 30(2): 214-9. Smith, H., F. Anderson, H. Raphael, P. Maslin, S. Crozier and C. Cooper. 2007. Effect of annual intramuscular vitamin D on fracture risk in elderly men and women—a population-based, randomized, double-blind, placebo-controlled trial. Rheumatology 46(12): 1852-7. Smith, S. M., K. K. Gardner, J. Locke and S. R. Zwart. 2009. Vitamin D supplementation dur- ing Antarctic winter. American Journal of Clinical Nutrition 89(4): 1092-8. Sowers, M. 1996. Pregnancy and lactation as risk factors for subsequent bone loss and osteo- porosis. Journal of Bone and Mineral Research 11(8): 1052-60. Sowers, M., D. Zhang, B. W. Hollis, B. Shapiro, C. A. Janney, M. Crutchfield, M. A. Schork, F. Stanczyk and J. Randolph. 1998. Role of calciotrophic hormones in calcium mobilization of lactation. American Journal of Clinical Nutrition 67(2): 284-91. Specker, B. L., M. L. Ho, A. Oestreich, T. A. Yin, Q. M. Shui, X. C. Chen and R. C. Tsang. 1992. Prospective study of vitamin D supplementation and rickets in China. Journal of Pediatrics 120(5): 733-9. Specker, B. L., A. Beck, H. Kalkwarf and M. Ho. 1997. Randomized trial of varying mineral intake on total body bone mineral accretion during the first year of life. Pediatrics 99(6): E12. Takeuchi, A., T. Okano, N. Tsugawa, Y. Tasaka, T. Kobayashi, S. Kodama and T. Matsuo. 1989. Effects of ergocalciferol supplementation on the concentration of vitamin D and its metabolites in human milk. Journal of Nutrition 119(11): 1639-46. Tang, B. M., G. D. Eslick, C. Nowson, C. Smith and A. Bensoussan. 2007. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 370(9588): 657-66. Trivedi, D. P., R. Doll and K. T. Khaw. 2003. Effect of four monthly oral vitamin D3 (cho- lecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. British Medical Journal 326(7387): 469. Tsai, K. S., H. Heath, 3rd, R. Kumar and B. L. Riggs. 1984. Impaired vitamin D metabolism with aging in women. Possible role in pathogenesis of senile osteoporosis. Journal of Clinical Investigation 73(6): 1668-72. Van Der Klis, F. R., J. H. Jonxis, J. J. Van Doormaal, P. Sikkens, A. E. Saleh and F. A. Muskiet. 1996. Changes in vitamin-D metabolites and parathyroid hormone in plasma following cholecalciferol administration to pre- and postmenopausal women in the Netherlands in early spring and to postmenopausal women in Curacao. British Journal of Nutrition 75(4): 637-46. van Schoor, N. M., M. Visser, S. M. Pluijm, N. Kuchuk, J. H. Smit and P. Lips. 2008. Vitamin D deficiency as a risk factor for osteoporotic fractures. Bone 42(2): 260-6. Vatanparast, H., D. A. Bailey, A. D. Baxter-Jones and S. J. Whiting. 2010. Calcium require- ments for bone growth in Canadian boys and girls during adolescence. British Journal of Nutrition: 1-6.

OCR for page 345
402 DIETARY REFERENCE INTAKES FOR CALCIUM AND VITAMIN D Viljakainen, H. T., A. M. Natri, M. Karkkainen, M. M. Huttunen, A. Palssa, J. Jakobsen, K. D. Cashman, C. Molgaard and C. Lamberg-Allardt. 2006. A positive dose–response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. Journal of Bone and Mineral Research 21(6): 836-44. Viljakainen, H. T., M. Vaisanen, V. Kemi, T. Rikkonen, H. Kroger, E. K. Laitinen, H. Rita and C. Lamberg-Allardt. 2009. Wintertime vitamin D supplementation inhibits seasonal variation of calcitropic hormones and maintains bone turnover in healthy men. Journal of Bone and Mineral Research 24(2): 346-52. Viljakainen, H. T., E. Saarnio, T. Hytinantti, M. Miettinen, H. Surcel, O. Makitie, S. Andersson, K. Laitinen and C. Lamberg-Allardt. 2010. Maternal vitamin D status determines bone variables in the newborn. Journal of Clinical Endocrinology and Metabolism 95(4): 1749-57. Wagner, C. L., T. C. Hulsey, D. Fanning, M. Ebeling and B. W. Hollis. 2006. High-dose vitamin D3 supplementation in a cohort of breastfeeding mothers and their infants: a 6-month follow-up pilot study. Breastfeeding Medicine 1(2): 59-70. Widdowson, E. M. 1965. Absorption and excretion of fat, nitrogen, and minerals from “filled” milks by babies one week old. Lancet 2(7422): 1099-105.