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      The 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D from the Institute of Medicine: What Clinicians Need to Know


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          This article summarizes the new 2011 report on dietary requirements for calcium and vitamin D from the Institute of Medicine (IOM). An IOM Committee charged with determining the population needs for these nutrients in North America conducted a comprehensive review of the evidence for both skeletal and extraskeletal outcomes. The Committee concluded that available scientific evidence supports a key role of calcium and vitamin D in skeletal health, consistent with a cause-and-effect relationship and providing a sound basis for determination of intake requirements. For extraskeletal outcomes, including cancer, cardiovascular disease, diabetes, and autoimmune disorders, the evidence was inconsistent, inconclusive as to causality, and insufficient to inform nutritional requirements. Randomized clinical trial evidence for extraskeletal outcomes was limited and generally uninformative. Based on bone health, Recommended Dietary Allowances (RDAs; covering requirements of ≥97.5% of the population) for calcium range from 700 to 1300 mg/d for life-stage groups at least 1 yr of age. For vitamin D, RDAs of 600 IU/d for ages 1–70 yr and 800 IU/d for ages 71 yr and older, corresponding to a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/liter), meet the requirements of at least 97.5% of the population. RDAs for vitamin D were derived based on conditions of minimal sun exposure due to wide variability in vitamin D synthesis from ultraviolet light and the risks of skin cancer. Higher values were not consistently associated with greater benefit, and for some outcomes U-shaped associations were observed, with risks at both low and high levels. The Committee concluded that the prevalence of vitamin D inadequacy in North America has been overestimated. Urgent research and clinical priorities were identified, including reassessment of laboratory ranges for 25-hydroxyvitamin D, to avoid problems of both undertreatment and overtreatment.


          There is an urgent clinical and public health need for consensus cut-points for serum 25OHD inadequacy to avoid problems of both under- and overtreatment.

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          Author and article information

          J Clin Endocrinol Metab
          The Journal of Clinical Endocrinology and Metabolism
          The Endocrine Society
          January 2011
          30 November 2010
          1 January 2011
          : 96
          : 1
          : 53-58
          Department of Nutritional Sciences (A.C.R.), Pennsylvania State University, University Park, Pennsylvania 16802; Department of Medicine (J.E.M.), Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02215; Department of Pediatrics (S.A.A.), Baylor College of Medicine, Houston, Texas 77030; Department of Medicine (J.F.A.), State University of New York at Stony Brook, Stony Brook, New York 11794; Winthrop University Hospital (J.F.A.), Mineola, New York 11501; Division of Nutritional Sciences (P.M.B), Cornell University, Ithaca, New York 14853; Division of Hematology and Oncology (S.K.C.), The Ohio State University, Columbus, Ohio 43210; Department of Epidemiology and Preventive Medicine (R.A.D.-A.), Loyola University Stritch School of Medicine, Maywood, Illinois 60153; Bone Metabolism Unit (J.C.G.), Creighton University Medical Center, Omaha, Nebraska 68131; Department of Medicine (R.L.G.), University of California, San Diego, La Jolla, California 92093; Department of Biochemistry (G.J.), Queen’s University, Kingston, Ontario, Canada K7L 3N6; Faculty of Medicine—Endocrinology (C.S.K.), Memorial University of Newfoundland, St. John’s, Newfoundland, Canada A1B 3V6; Department of Epidemiology and Public Health (S.T.M.), Yale School of Public Health, New Haven, Connecticut 06520; Center for Clinical and Translational Medicine (C.J.R.), Maine Medical Center Research Institute, Scarborough, Maine 04074; and Department of Nutritional Sciences (S.A.S.), Rutgers University, New Brunswick, New Jersey 08901
          Author notes

          Address all correspondence and requests for reprints to: Dr. Catharine Ross, Pennsylvania State University, 110 Chandlee Laboratory, University Park, Pennsylvania 16802. E-mail: acr6@ 123456psu.edu .

          Copyright © 2011 by The Endocrine Society

          This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/us/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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