Ross A Catharine, Manson Joann E, Abrams Steven A, Aloia John F, Brannon Patsy M, Clinton Steven K, Durazo-Arvizu Ramon A, Gallagher J Christopher, Gallo Richard L, Jones Glenville, Kovacs Christopher S, Mayne Susan T, Rosen Clifford J, Shapses Sue A
The Pennsylvania State University, University Park, PA, USA.
J Am Diet Assoc. 2011 Apr;111(4):524-7. doi: 10.1016/j.jada.2011.01.004.
The Institute of Medicine Committee to Review Dietary Reference Intakes for Calcium and Vitamin D comprehensively reviewed the evidence for both skeletal and nonskeletal health outcomes and concluded that a causal role of calcium and vitamin D in skeletal health provided the necessary basis for the 2011 Estimated Average Requirement (EAR) and Recommended Dietary Allowance (RDA) for ages older than 1 year. For nonskeletal outcomes, including cancer, cardiovascular disease, diabetes, infections, and autoimmune disorders, randomized clinical trials were sparse, and evidence was inconsistent, inconclusive as to causality, and insufficient for Dietary Reference Intake (DRI) development. The EAR and RDA for calcium range from 500 to 1,100 and 700 to 1,300 mg daily, respectively, for ages 1 year and older. For vitamin D (assuming minimal sun exposure), the EAR is 400 IU/day for ages older than 1 year and the RDA is 600 IU/day for ages 1 to 70 years and 800 IU/day for 71 years and older, corresponding to serum 25-hydroxyvitamin D (25OHD) levels of 16 ng/mL (40 nmol/L) for EARs and 20 ng/mL (50 nmol/L) or more for RDAs. Prevalence of vitamin D inadequacy in North America has been overestimated based on serum 25OHD levels corresponding to the EAR and RDA. Higher serum 25OHD levels were not consistently associated with greater benefit, and for some outcomes U-shaped associations with risks at both low and high levels were observed. The Tolerable Upper Intake Level for calcium ranges from 1,000 to 3,000 mg daily, based on calcium excretion or kidney stone formation, and from 1,000 to 4,000 IU daily for vitamin D, based on hypercalcemia adjusted for uncertainty resulting from emerging risk relationships. Urgently needed are evidence-based guidelines to interpret serum 25OHD levels relative to vitamin D status and intervention.
医学研究所钙和维生素D膳食参考摄入量审查委员会全面审查了骨骼和非骨骼健康结果的证据，并得出结论，钙和维生素D在骨骼健康中的因果作用为2011年1岁以上人群的估计平均需求量（EAR）和推荐膳食摄入量（RDA）提供了必要依据。对于非骨骼结果，包括癌症、心血管疾病、糖尿病、感染和自身免疫性疾病，随机临床试验较少，证据不一致，因果关系尚无定论，且不足以制定膳食参考摄入量（DRI）。1岁及以上人群的钙EAR和RDA分别为每日500至1100毫克和700至1300毫克。对于维生素D（假设阳光照射极少），1岁以上人群的EAR为每日400国际单位，1至70岁人群的RDA为每日600国际单位，71岁及以上人群为每日800国际单位，对应的血清25-羟基维生素D（25OHD）水平，EAR为16纳克/毫升（40纳摩尔/升），RDA为20纳克/毫升（50纳摩尔/升）或更高。根据与EAR和RDA对应的血清25OHD水平，北美维生素D不足的患病率被高估了。较高的血清25OHD水平与更大益处之间并非始终相关，对于某些结果，观察到低水平和高水平风险时呈U形关联。基于钙排泄或肾结石形成，钙的可耐受最高摄入量为每日1000至3000毫克，基于新兴风险关系调整不确定性后的高钙血症，维生素D为每日1000至4000国际单位。迫切需要基于证据的指南来解释血清25OHD水平与维生素D状态及干预的关系。
