New data on adverse outcomes due to excess calcium intake among children and adolescents—specifically data that would identify a NOAEL or LOAEL—have not emerged since the last DRI report on calcium in 1997 (IOM, 1997). At that time, it was noted that the safety of excess calcium intake in children and adolescents had not been studied. A UL of 2,500 mg of calcium per day was established in 1997 for all children and adolescents in these life stage groups, largely on the basis of the UL established for adults (i.e., 2,500 mg/day) (IOM, 1997).
There is currently no evidence that the 1997 level is too low to provide public health protection for this group; further, when compared with the new UL set for infants, the level of 2,500 mg of calcium per day is a reasonable increase given the expected increases in body weight and metabolic capacities, especially for younger children between the ages of 1 and 8 years.
However, for older children it is also appropriate to take into account the likely increases in tolerated intakes as metabolic demands increase and the pubertal growth spurt associated with bone accretions sets in, primarily between 9 and 18 years of age. Again, there are no data to allow quantitative uncertainty factors to be developed to mathematically correct for the likelihood of increased capacities during the bone growth spurt, but to do so in some fashion is consistent with a general toxicological approach. An added level of 500 mg/day is reasonable, resulting in a UL of 3,000 mg of calcium per day for children 9 to 13 years of age and adolescents 14 to 18 years of age.
The UL for children 1 through 8 years of age is the same as that established for these life stage groups in 1997 (IOM, 1997). However, the UL has been increased by 500 mg/day for older children and adolescents compared with 1997 (IOM, 1997). This is based on a biologically reasonable adjustment intended to take into account increased need and therefore increased capacity to tolerate a slight increase in a UL value.
The onset of hypercalcemia is clearly an adverse outcome. However, it was not selected as an indicator for ULs for adults because it reflects an