The 2011 Dietary Reference Intakes for Calcium and Vitamin D: what dietetics practitioners need to know.
Level 5 - mechanism / opinion, no new human data
Narrative overview and clinical summary of an expert committee report (Institute of Medicine DRIs)
PubMed 21443983 · doi:10.1016/j.jada.2011.01.004
What was done
The Institute of Medicine (IOM) Committee reviewed clinical and observational evidence on skeletal and nonskeletal health outcomes (including cancer, cardiovascular disease, diabetes, infections, and autoimmune disorders) to update the 2011 Dietary Reference Intakes (DRIs), Estimated Average Requirements (EAR), Recommended Dietary Allowances (RDA), and Tolerable Upper Intake Levels (UL) for calcium and vitamin D.
What was found
Causal evidence was sufficient only for skeletal health outcomes. For calcium, the EAR was established at 500 to 1,100 mg/day and the RDA at 700 to 1,300 mg/day for individuals older than 1 year, with a UL of 1,000 to 3,000 mg/day. For vitamin D, assuming minimal sun exposure, the EAR was set at 400 IU/day (target serum 25-hydroxyvitamin D [25OHD] of 16 ng/mL [40 nmol/L]) and the RDA at 600 IU/day for ages 1 to 70 years and 800 IU/day for ages 71 years and older (target serum 25OHD of 20 ng/mL [50 nmol/L] or more). The UL for vitamin D was set at 1,000 to 4,000 IU/day. Evidence for nonskeletal outcomes was deemed sparse and inconclusive, with some outcomes showing U-shaped risk curves at higher serum levels.
Why it matters
This review clarified that high-dose vitamin D supplementation for nonskeletal disease prevention lacks conclusive trial evidence, and it established that a serum 25OHD concentration of 20 ng/mL is sufficient for skeletal health in the vast majority of the population.
Limits
The abstract provides a narrative summary of guideline recommendations rather than primary trial data. Evidence supporting nonskeletal benefits was limited by a lack of randomized clinical trials, and optimal cutoffs for circulating 25OHD levels remain debated across clinical guideline bodies.
Cited by
- supports The Institute of Medicine set 4,000 IU per day as the tolerable upper intake level for vitamin D3.