Dietary Reference Intakes For Calcium Research Articles

Picky Eating Is Associated with Lower Nutrient Intakes from Children's Home-Packed School Lunches.

The objective was to assess the relationship between children’s picky eating (PE) status and nutrient intake from home-packed school lunches. The lunches of 321 students, aged 7–10 years, were quantified via cross-sectional direct observation. Children were classified as having PE (n = 155) or not (non-PE; n = 166) based on food neophobia scores and parental perceptions of PE. The PE group consumed significantly less protein, folate, magnesium, potassium, zinc, and vitamins B1, B2, B3, B6, D, and E than the non-PE group; however, both groups consumed amounts exceeding Dietary Reference Intakes (DRIs) for protein, carbohydrates, sugar, sodium, iron, and vitamins B1, B2, B3, B6, B12, and C. Conversely, both groups consumed amounts significantly lower than DRIs for calcium, fibre, folate, magnesium, potassium, zinc, and vitamins A, D, E, and K. The PE group ate significantly less meat and alternatives, vegetables and fruit, and fruit than the non-PE group, and did not meet any of Canada’s Food Guide (2007) recommendations. The non-PE group met recommendations for meat and alternatives only. PE impacts the dietary intake of children’s home-packed lunches; however, many packed lunches were of low nutritional quality. Focus should be placed on provision of nutritionally complete school lunches for all children.

The prevalence and risk of missing outcome data in prenatal vitamin D supplemented gestational diabetes mellitus patients: a systematic review and meta-analysis protocol

The prevalence and risk of missing outcome data in prenatal vitamin D supplemented gestational diabetes mellitus patients: a systematic review and meta-analysis protocol

Vitamin D supplementation for sickle cell disease.

Vitamin D supplementation for sickle cell disease.

Commentary: Myths and facts on vitamin D amidst the COVID-19 pandemic

Commentary: Myths and facts on vitamin D amidst the COVID-19 pandemic

Melanin has a Small Inhibitory Effect on Cutaneous Vitamin D Synthesis: A Comparison of Extreme Phenotypes

Epidemiology suggests that melanin inhibits cutaneous vitamin D3 synthesis by UVR. Laboratory investigations assessing the impact of melanin on vitamin D production have produced contradictory results. We determined the effect of melanin on vitamin D3 photosynthesis in healthy young volunteers (n= 102) of Fitzpatrick skin types II-VI (white to black). Participants, irrespective of skin type, were exposed to the same suberythemal UVR dose, to 85% body surface area, using solar simulated UVR or narrowband UVB (311 nm). This was repeated five times with intervals of 3-4 days between UVR exposures. Blood was taken before, during, and after the irradiation and assessed for serum 25-hydroxyvitamin D3 (25[OH]D3) as a marker of vitamin D3 status. Linear UVR dose-dependent increases in 25(OH)D3 were highly significant (P ≤ 7.7 x 10-11). The ratios of regression slopes of the different skin type groups were compared, and only skin type II was significantly steeper than the other groups. Comparisons between extreme skin types II and VI showed melanin inhibition factors of approximately 1.3-1.4, depending on the UVR source. We conclude that the inhibitory effect of melanin on vitamin D3 synthesis is small, compared with erythema, but that this difference may be sufficient to explain the epidemiological data.

SUN-539 Low Dietary Calcium Intake Among Adolescents and Young Adults in Brasilia, Brazil

INTRODUCTION Peak bone mass, which is the maximal bone mass accrued by an individual by the time it is reached the skeletal maturation, presents a determinant role in bone health throughout adulthood. It is attained between the end of the second and the beginning of the third decade of life, being 40 to 60% of its amount acquired during adolescence. Calcium is an essential mineral for bone formation. So, it is of paramount importance that adolescents and young adults meet their Dietary Reference Intake for calcium (DRI-Ca) to assure adequate bone mass acquisition. Several recent studies, both in our country and in a worldwide context, have shown that a significant proportion of individuals at those ages do not reach their DRI-Ca. AIM OF THE STUDY: Recognize the calcium dietary intake (Ca-DI) among a small sample sized group of teenagers and young adults in Brasilia, Brazil, and compare the obtained data with the recommended DRI-Ca according to the specific age group. It corresponds to the preliminary branch of a more robust ongoing study. PATIENTS AND METHODS Cross sectional pilot study carried out with 15 to 18-year-old adolescents and 19 to 23-year-old young adults attending a university health fair. It was used a validated questionnaire and Ca-DI was determined using the International Osteoporosis Foundation calculator. The obtained data was compared to the DRI-Ca according to the age range: 1,300 mg/day for the adolescent group and 1,000 mg/day for young adults (Institute of Medicine, USA) . RESULTS Thirty-four individuals were included (20 females). Mean age was 18.9 ± 2 yr. Sixteen individuals (12 females) were in the adolescent group and 18 (8 females) in the young adult one. Average Ca-DI for both groups were below their respective DRI-Ca. Mean Ca-DI was 751.8 ± 384 mg/day (57.8 ± 29.5% of DRI-Ca) in the adolescent group, with no difference between sexes (p = 0.22). In the young adult group mean Ca-DI was 792.8 ± 346.6 mg/day (79.3 ± 34.7% of DRI-Ca). In the latter group female individuals showed significantly lower (615.5 ± 131.2 mg) Ca-DI when compared to males (934.6 ± 404 mg), p = 0.038. There was no statistical difference when comparing both age groups regarding their reached percentage of DRI-Ca (p = 0.06). CONCLUSION Although these results were based on a small preliminary cross-sectional study, they may signalize a real warning concerning low Ca dietary intake among adolescents and young adults in our population, especially by the female young adult group.

Vitamin D status in scarring and nonscarring alopecia

Vitamin D status in scarring and nonscarring alopecia

Vitamin D supplementation for sickle cell disease.

Vitamin D supplementation for sickle cell disease.

Decreased Nutrient Intake Is Associated With Premature Cervical Remodeling

ObjectiveTo examine the direct relationship between nutrient intake and cervical remodeling. DesignLongitudinal descriptive design. SettingMaternal–fetal medicine clinic in a Midwestern urban city. ParticipantsForty-seven pregnant African American women. MethodsParticipants completed the Block brief food frequency questionnaire at 19 to 24 weeks and 27 to 29 weeks gestation and had quantitative ultrasonic attenuation estimates at 19 to 21 weeks, 23 to 25 weeks, 27 to 29 weeks, 31 to 33 weeks, and 35 to 37 weeks gestation. ResultsTrajectory mixture models identified two subpopulations within our sample: those at risk (n = 36) and at less risk (n = 11) for premature cervical remodeling. More participants in the less-risk group consumed the dietary reference intake for calcium, vitamin A, folate, vitamin E, zinc, and vitamin D than in the at-risk group. The percentage of participants in the less-risk group who consumed the recommended dietary reference intake for vitamin E was twice the percentage of women in the at-risk group (82% and 44%, respectively; p = .004). Mean intake of calcium was almost 1.3 times more (p = .05) and for zinc was 1.5 times more (p = .04) in the less-risk group than in the at-risk group. ConclusionPractitioners can inform women that certain nutrients, particularly zinc, calcium, and vitamin E, could be important to the health of the cervix and inhibit premature cervical remodeling, which in turn may help prevent preterm birth.

69-Year-Old Woman With Confusion and Fatigue

Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN (H.M.K.); Advisor to resident and Consultant in Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN (A.E.K.). A 69-year-old woman presented to her primary care physicianwith a 4-day history of fatigue and dizziness. She was 45 minutes late for her appointment because she had trouble driving to the office. She reported no motor or sensory deficits but had difficulty with coordination. Review of systems was positive for dysuria and urinary frequency. She did not have fever, chills, weight or appetite changes, respiratory, cardiac, or gastrointestinal symptoms, or recent head trauma. The patient’s medical history was remarkable for hypertension, hyperlipidemia, type 2 diabetes mellitus, osteoporosis, and gastroesophageal reflux disease. Medications included metoprolol tartrate, lisinopril with hydrochlorothiazide, lovastatin, cholecalciferol, and as-needed calcium carbonate. She had smoked half a pack of cigarettes per day for 40 years but had quit smoking 6 years previously. She didnot use alcohol or illicit drugs. On examination, the patient was afebrile with a blood pressure of 104/67 mm Hg, heart rate of 76 beats/min, respiratory rate of 17 breaths/min, oxygen saturation of 94% while breathing room air, and body mass index (calculated as weight in kilograms divided by height inmeters squared) of 39 kg/m. Shewas alert and oriented to person, place, and time. Her speech was dysarthric, and she had difficulty following simple commands. Her coordination was impaired with symmetric dysmetria on finger-to-nose testing, heel-kneeshin testing, and rapid alternating movements. Cranial nerves II through XII were intact. Results of motor and sensory examinations were within normal limits. Reflexes were symmetric. Lymph node, thyroid, cardiac, respiratory, gastrointestinal, musculoskeletal, and skin examinations identified no abnormalities.

Rising trend in vitamin D status from 1993 to 2013: dual concerns for the future.

BackgroundThe Institute of Medicine 2011 Report on Dietary Reference Intakes for Calcium and Vitamin D specified higher intakes for all age groups compared to the 1997 report, but also cautioned against spurious claims about an epidemic of vitamin D deficiency and against advocates of higher intake requirements. Over 40 years, we have noted marked improvement in vitamin D status but we are concerned about hypervitaminosis D.ObjectiveWe sought to evaluate the 25-hydroxyvitamin D (25OHD) trend over 20 years.DesignWe retrieved all results of serum 25OHD from 1993 to 2013 (n=69 012) that was trimmed to one sample per person (n=43 782). We conducted a time series analysis of the monthly averages for 25OHD using a simple sequence chart and a running median smoothing function. We modelled the data using univariate auto-regressive integrated moving average (ARIMA) and forecast 25OHD levels up to 2016.ResultsThe time series sequence chart and smoother function demonstrated a steady upward trend with seasonality. The yearly average 25OHD increased from 36.1 nmol/l in 1993 to 57.3 nmol/l in 2013. The ARIMA model was a good fit for the 25OHD time series; it forecasted monthly average 25OHD up to the end of 2016 with a positive stationary R 2 of 0.377.ConclusionsVitamin D status improved over the past 40 years, but there remains a dual problem: there are groups at risk of vitamin D deficiency who need public health preventative measures; on the other hand, random members of the population are taking unnecessarily high vitamin D intakes for unsubstantiated claims.

Vitamin D supplementation should be routine in pregnancy: AGAINST: Proven benefits of vitamin D supplementation remain elusive.

Obstetricians have an unfortunate track record of implementing interventions before they are properly evaluated—examples include thalidomide for pregnancy nausea, tocolytics to suppress preterm labour, and vitamins C and E for the prevention of pre-eclampsia. In 2012 the Chief Medical Officers of the UK (Vitamin D—advice on supplements for at risk groups) recommended that, ‘All pregnant and breastfeeding women should take a daily supplement containing 10 μg of vitamin D’. However, as recently as 2003 the National Collaborating Centre for Women's and Children's Health antenatal care guideline (p.42) had recommended that ‘There is insufficient evidence to evaluate the effectiveness of vitamin D in pregnancy. In the absence of evidence of benefit, vitamin D supplementation should not be offered routinely to pregnant women’. This was updated in 2008 (p.12) to ‘women may choose to take 10 μg of vitamin D per day’ and supplementation was only ‘advised’ in women in high-risk groups (essentially, those with pigmented skin, or who usually remain covered when outdoors, or who have a poor diet, or are obese). There have been claims for the benefits of vitamin D in almost every pathological condition, and yet proven benefits remain elusive (Harvey BMJ 2012;345:e4695). The US Institute of Medicine in 2010 (Dietary Reference Intakes for Calcium and Vitamin D) concluded that, ‘More targeted research should continue. Higher levels have not been shown to confer greater benefits, and in fact, they have been linked to other health problems, challenging the concept that “more is better”. There is emerging evidence that too much of these nutrients may be harmful’. The Committee on Obstetric Practice of the American College of Obstetricians and Gynecologists (Vitamin D: Screening and Supplementation During Pregnancy) stated in July 2011 that, ‘At this time there is insufficient evidence to support a recommendation for screening all pregnant women for vitamin D deficiency’ and suggested that ‘vitamin D supplementation during pregnancy beyond that contained in a prenatal vitamin should await the completion of ongoing randomized clinical trials’. A 2013 comment in the Lancet suggested that the safest approach was to recommend supplementation only in high risk women as defined by the National Institute of Health and Clinical Excellence (NICE) (Steer Lancet 2013;381:2143–5). The latest Health Technology Assessment review of vitamin D supplementation in pregnancy (Health Technol Assess 2014;18:1–190) has concluded that ‘It is not possible to make rigorously evidence-based recommendations regarding maternal vitamin D supplementation during pregnancy’ and added ‘Although modest doses of vitamin D in pregnancy might well be relatively safe, at least in the short term, there are no long-term data to inform their potential long-term effects on offspring health. As with most interventions, it is probably optimistic to expect that there will be no risk of adverse events’. Surely it is time that we learned to do the proper studies before making potentially harmful recommendations. Philip Steer is Emeritus Editor, BJOG. For a full disclosure of interests, please go to www.BJOG.org.

Calcium requirements for Chinese adults by cross-sectional statistical analyses of calcium balance studies: an individual participant data and aggregate data meta-regression

Background Chinese dietary reference intakes for calcium are largely based on foreign studies. We undertook meta-regression to estimate calcium requirements for Chinese adults derived from calcium balance data in Chinese adults. Methods We searched PubMed, Cochrane CENTRAL, and SinoMed from inception to March 5, 2014, by using a structured search strategy. The bibliographies of any relevant papers and journals were also screened for potentially eligible studies. We extracted a standardized data set from studies in Chinese adults that reported calcium balance data. The relationship between calcium intake and output was examined by an individual participant data (IPD) and aggregate data (AD) meta-regression. Results We identified 11 metabolic studies in Chinese adults within 18–60 years of age. One hundred and forty-one IPD (n=35) expressed as mg/d, 127 IPD (n=32) expressed as mg·kg body wt-1·d-1, and 44 AD (n=132) expressed as mg/d were collected. The models predicted a neutral calcium balance (defined as calcium output (Y) equal to calcium intake (C)) at intakes of 460 mg/d (Y=0.60C+183.98) and 8.27 mg·kg body wt-1·d-1 (Y=0.60C+3.33) for IPD, or 409 mg/d (Y=0.66C+139.00) for AD. Calcium requirements at upper intakes were higher than that at lower intakes in all these models. Conclusion Calcium requirement for Chinese adults 18–60 years of age approximately ranges between 400 mg/d and 500 mg/d when consuming traditional plant-based Chinese diets.

A multi‐center assessment of the nutritional quality of hospital patient menus (393.7)

In Canada, there are no widely accepted standards for hospital menu planning. The objective of this study was to evaluate the quality of nutrients and foods served on hospital patient menus. At 3 acute care hospitals in Ontario, Canada (Nov‐Aug 2011), 84 standard menus and 2234 consecutive patient‐selected menus were evaluated in regular and diabetic diets, and 3000 mg and 2000 mg sodium restricted diets. Comparisons were made against the Dietary Reference Intakes (DRI) and Canada’s Food Guide. Energy levels ranged from 1281 ‐ 3007 kcal and 45% of standard menus had < 1600 kcal. Protein ranged from 49 ‐ 159 g and 30% of standard menus had < 60 g. The standard regular menu, the most commonly prescribed, had 1673 ± 362 kcal and 63 ± 9 g protein. Energy and protein levels were highest in diabetic menus. All standard regular and diabetic menus fell within the Acceptable Macronutrient Distribution Range. The proportion of regular standard menus meeting the DRIs were 0% for calcium, sodium, and fibre; 50% for Vitamin C; and 86% for iron. 100% of sodium‐restricted menus fell below the DRI for calcium. Most menus met Milk & Alternatives recommendations, though only 27% met Vegetables and Fruit, 11% met Grain Products, and 8% met Meat & Alternatives recommended servings. These data show that patient menus did not consistently meet recommendations for macronutrient and vitamin and minerals or for the number of Canada’s Food Guide servings, which may contribute to malnutrition. This data supports the need for policies guiding food procurement and menu planning in hospitals.

Vitamin D and Calcium

This chapter provides a summary of the literature including results from large trials, meta-analyses, and recent major recommendations. Two well-accepted and recent recommendations include those from the Agency for Health Research and Quality on calcium and vitamin D supplementation and from the Institute of Medicine's dietary reference intakes for calcium and vitamin D. This review suggests that there is strong evidence for synergistic roles of calcium and vitamin D in maintaining bone health in postmenopausal women, but the correlation between vitamin D alone and bone health is overall inconclusive.

Literature search and review related to specific preparatory work in the establishment of Dietary Reference Values for Phosphorus, Sodium and Chloride

Literature search and review related to specific preparatory work in the establishment of Dietary Reference Values for Phosphorus, Sodium and Chloride

Critical assessment of high-circulation print newspaper coverage of the Institute of Medicine report Dietary Reference Intakes for Calcium and Vitamin D.

To evaluate high-circulation US and Canadian newspaper coverage of the Institute of Medicine (IOM) report Dietary Reference Intakes for Calcium and Vitamin D and assess pre-report and post-report reporter-specific vitamin D-related coverage. Two independent reviewers analysed the newspaper articles. The key report findings cited, proportion of sentences describing the IOM report and proportion of sentences describing critical viewpoints on the report were calculated. The content of articles written by reporters with a history of pre-report vitamin D-related articles was compared with that of articles written by reporters without such a history. Factiva and LexisNexis searches of the top thirty US and three English-language Canadian print newspapers, by circulation. Articles on the IOM report published from 30 November to 21 December 2010 and previous vitamin D-related articles written by the same reporters. Only ten articles met inclusion/exclusion criteria. Articles inconsistently cited the key findings in the IOM report. Reporters with a history of pre-report articles highlighting the benefits of vitamin D dedicated a greater proportion of sentences to viewpoints critical of the IOM report (P < 0·01). There was no significant difference between pre-report publication history and proportion of sentences focused on the IOM report. A borderline-significant difference (P = 0·058) was observed between pre-report articles highlighting the benefits of vitamin D and the absence of reference to potential risks of vitamin D overconsumption. Our findings suggest that newspaper articles did not consistently or comprehensively report the IOM recommendations and that pre-report publication history of reporters was related to post-report article content.

Associations of diet and supplement use with birth size in HIVinfected pregnant women

Our objective was to examine associations of diet and supplement (supps) use in the 3rd trimester of pregnancy with birth size in 265 HIV‐infected (HIV+) women in PHACS. We administered three 24‐hour multiple pass dietary recalls over 2 weeks. We fit linear regression models to evaluate associations of each nutrient with Z‐scores for birth weight (BWZ) and length (BLZ), adjusted for maternal birth outside US, BMI, and kcal/day. Mean age was 28y; 68% were black, 76% were US‐born, 54% had income &lt; $10,000/yr, mean BMI was 27. Median [IQR] intakes were 2,030 [1551, 2523] kcal/day, 78 [62, 95] g protein, 14 [10, 18] g fiber, 32% [28, 37] calories from fat, and 94% used supps. Many women consumed less than the dietary reference intake (DRI) in pregnancy (diet + supps) for protein (40%), fiber (95%), calcium (41%), vitamin D (57%), folate (13%), iron (14%), N‐3 fatty acids (40%) and other nutrients. Mean BWZ was lower for women with intakes &lt;DRI for calcium (−0.23 [95% confidence interval: −0.47, 0.02]), iron (−0.37 [−0.69, −0.06]), folate (−0.31 [−0.63, 0.01]) and vitamin B6 (−0.35 [−0.74, 0.05]); and mean BLZ was lower for intakes &lt;DRI for calcium (−0.26 [−0.53, 0.01]) and folate (−0.29 [−0.64, 0.06]). Low maternal nutrient intake may impact birth size, but these associations may be confounded by other factors and thus require more investigation. Supported by NICHD.

Magnesium

Magnesium

Do we need to take calcium with vitamin D supplements to prevent falls, fractures, and death?

The 2011 report by the US Institute of Medicine (IOM) on dietary reference intakes for calcium and vitamin D is based on meta-analyses of randomized controlled trials (RCTs), which concluded that vitamin D supplements need to be taken with calcium supplements to prevent falls, fractures, and all-cause mortality. This study reviews recent meta-analyses of RCTs of vitamin D supplementation to determine whether their conclusions are consistent with the meta-analyses underpinning the IOM report. Since 2007 when the first IOM meta-analysis was published, up to May 2012, there have been nine meta-analyses of RCTs of vitamin D supplements on risk of falls, 10 on fractures, and five on all-cause mortality. About half of these reported summary effects for both vitamin D combined with calcium supplements and also vitamin D alone. However, statistical testing of results from recent meta-analyses does not support the conclusions of the IOM meta-analyses. The inconsistency in the conclusions from meta-analyses is due to limitations in the design of previous RCTs of vitamin D supplementation. Large RCTs, giving higher doses of vitamin D (without calcium), should provide a clear answer within several years as to whether vitamin D supplements are beneficial by themselves.