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Dietary Reference Intakes for Calcium and Vitamin D (2011)
Food and Nutrition Board (FNB)

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. "6 Tolerable Upper Intake Levels: Calcium and Vitamin D." Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.

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DRI Dietary Reference Intakes Calcium Vitamin D

BOX 6-1

Potential Indicators of Adverse Outcomes for Excess Intake of Calcium and Vitamin D

Calcium

  • Hypercalcemia

  • Hypercalciuria

  • Vascular and soft tissue calcification

  • Nephrolithiasis (kidney stones)

  • Prostate cancer

  • Interactions with iron and zinc

  • Constipation

Vitamin D

  • Intoxication and related hypercalcemia and hypercalciuria

  • Serum calcium

  • Measures in infants: retarded growth, hypercalcemia

  • Emerging evidence for all-cause mortality, cancer, cardiovascular risk, falls and fractures

tors, but also indicated that the scientific judgment involved should be described. In developing ULs for calcium and vitamin D, the limited nature of the data resulted in the committee using UFs to adjust for uncertainties in the data. These were necessarily qualitative adjustments rather than quantitative adjustments. As suggested repeatedly during the 2007 workshop on DRIs (IOM, 2008), an educated guess for a reference value is more useful to stakeholders than the failure to set a reference value in the face of uncertainty.

Discussions related to calcium ULs are provided first, and then vitamin D ULs are considered. At the start, the committee identified potential indicators to assess adverse effects for excess intakes of calcium and vitamin D based on the available literature, as described below. The potential indicators considered are presented in Box 6-1.

CALCIUM UPPER LEVELS: REVIEW OF POTENTIAL INDICATORS AND SELECTION OF INDICATORS

Excess calcium intake from foods alone is difficult if not impossible to achieve. Rather, excess intakes are more likely to be associated with the use of calcium supplements. However, the potential indicators for the adverse outcomes of excessive calcium intake are not characterized by a robust

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405
Front Matter (R1-R16)
Summary (1-14)
1 Introduction (15-34)
2 Overview of Calcium (35-74)
3 Overview of Vitamin D (75-124)
4 Review of Potential Indicators of Adequacy and Selection of Indicators: Calcium and Vitamin D (125-344)
5 Dietary Reference Intakes for Adequacy: Calcium and Vitamin D (345-402)
6 Tolerable Upper Intake Levels: Calcium and Vitamin D (403-456)
7 Dietary Intake Assessment (457-478)
8 Implications and Special Concerns (479-512)
9 Information Gaps and Research Needs (513-522)
Appendix A: Acronyms, Abbreviations, and Glossary (523-536)
Appendix B: Issues and Interests Identified by Study Sponsors (537-538)
Appendix C: Methods and Results from the AHRQ-Ottawa Evidence-Based Report on Effectiveness and Safety of Vitamin D in Relation to Bone Health (539-724)
Appendix D: Methods and Results from the AHRQ-Tufts Evidence-Based Report on Vitamin D and Calcium (725-1012)
Appendix E: Literature Search Strategy (1013-1018)
Appendix F: Evidence Maps (1019-1024)
Appendix G: Cases Studies of Vitamin D Toxicity (1025-1034)
Appendix H: Estimated Intakes of Calcium and Vitamin D from National Surveys (1035-1044)
Appendix 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 (1045-1058)
Appendix J: Workshop Agenda and Open Session Agendas (1059-1064)
Appendix K: Biographical Sketches of Committee Members (1065-1074)
Index (1075-1102)
Summary Tables: Dietary Reference Intakes (1103-1116)