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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride
large share of the ingested nutrients is converted into tissue mass), but it has no demonstrable relevance in adults. An optimal ratio ensures that, if intake of one nutrient is adequate for growth, the intake of the associated nutrient will also be adequate without a wasteful surplus of one or the other. However, the ratio by itself is of severely limited value, in that there is little merit to having the ratio “correct” if the absolute quantities of both nutrients are insufficient to support optimal growth.
Furthermore, the intake ratio, by itself, fails to take into account both differing bioavailabilities and physiological adaptive responses. For example, in term-born infants during the first year of life, a higher calcium content of soy-based formulas was found to reduce phosphorus absorption, but phosphorus retention was similar because of offsetting changes in renal phosphorus output (DeVizia et al., 1985). Substitution of lactose with sucrose and/or hydrolyzed corn syrup solids had no effect on the efficiency of phosphorus absorption from formulas based on cow milk (Moya et al., 1992) or soy protein (Ziegler and Fomon, 1983).
Estimates of optimal Ca:P intake ratios have frequently been based on the calcium and phosphorus needs of bone building. The molar ratio of Ca:P in synthetic hydroxyapatite is 1.67:1; in actual bone mineral, usually closer to 1.5:1; and in amorphous calcium-phosphate (the first mineral deposited at the mineralizing site), 1.3:1 (Nordin, 1976). However, during growth, soft tissue will be accreting phosphorus as well. On average, lean soft tissue growth accounts for about 1 mmol (31 mg) phosphorus for every 5 mmol (155 mg) added to bone (Diem, 1970). Since soft tissue accretion of calcium is negligible compared with skeletal calcium accretion, an absorbed Ca:P molar ratio sufficient to support the sum of bony and soft tissue growth would be ~1.3:1 (assuming equivalent degrees of renal conservation of both nutrients). The corresponding ingested intake ratio must consider the differing absorption efficiencies for dietary calcium and phosphorus. In infants, with net absorptions for calcium and phosphorus of approximately 60 and 80 percent respectively, the intake ratio matching tissue accretion would be ~2:1 (see also the section “Birth through 12 Months, ” below). This value is somewhat higher than the Ca:P molar ratio of human milk, which in most populations is in the range of 1.5:1 (Fomon and Nelson, 1993).
Human milk must be presumed to be optimal for the infant's nutritional needs. The disparity between its ratio of ~1.5:1 and the ingested ratio calculated above reflects both the uncertainties in