For adults, the main criterion that the FNB used to establish the RDAs was the amount needed to promote bone maintenance and neutral calcium balance. Calcium intake and mortality from all causes, cancer, and cardiovascular disease: the Cancer Prevention Study II Nutrition Cohort. Am J Kidney Dis 2003;42:1253-9. [, Paik JM, Curhan GC, Sun Q, Rexrode KM, Manson JE, Rimm EB, et al. The RDA, with a 98% probability of adequacy, isdesigned to be the target nutrient intake for individuals; in contrast,the EAR has only a 50% probability of adequacy. Postmenopausal women [, Chung M, Tang AM, Newberry SJ. [, Crandall CJ, Aragaki AK, LeBoff MS, Li W, Wactawski-Wende J, Cauley JA, et al. Several large observational studies have shown an association between lower calcium intakes and higher risk of hypertension, stroke, and atherosclerosis. Most clinical trial evidence does not support a beneficial effect of calcium supplements on cancer incidence. High calcium intakes might also increase the risk of CVD (see section on CVD in "Calcium and Health" section above) [39,62,67,69,70] and prostate cancer (see "Other Cancers" in "Calcium and Health" section above for more details) [57,58], although not all studies confirm these findings. [, Keum N, Aune D, Greenwood DC, Ju W, Giovannucci EL. [, Kesse E, Bertrais S, Astorg P, Jaouen A, Arnault N, Galan P, et al. Adolescence: 66 mg. JBMR Plus 2020;4:e10246. Estimated Energy Requirement (EER) . Nutr Cancer 2009;61:47-69. [, Reyes-Garcia R, Mendoza N, Palacios S, Salas N, Quesada-Charneco M, Garcia-Martin A, et al. Absorption from supplements is highest with doses of 500 mg or less [15]. J Physiol Sci 2019;69:683-96. In: Marriott BP, Birt DF, Stallings VA, Yates AA, eds. In addition, when 132,823 adults (mean age 63 years) were followed for an average of 17.5 years, the risk of CVD mortality was 22% higher in men with calcium supplement intakes of 1,000 mg/day or more than in those not taking calcium supplements [47]. Baltimore, MD: Lippincott Williams & Wilkins; 2014:133-49. Dietary Goals for the United States. The effects of vitamin D, K and calcium co-supplementation on carotid intima-media thickness and metabolic status in overweight type 2 diabetic patients with CHD. DOI: 10.17226/1349 Excerpt Since its introduction in 1943 Recommended Dietary Allowanceshas become the accepted source of nutrient allowances for healthy people. [, Ananth CV, Keyes KM, Wapner RJ. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. For breast cancer, observational studies have had mixed findings on whether higher calcium intakes are associated with a lower risk. Amounts of calcium in supplements vary widely; multivitamin/mineral supplements commonly contain about 200 to 300 mg, and common amounts in calcium or calcium plus vitamin D supplements are 500 or 600 mg [14]. Folic Acid. One analysis of results from 35,983 women aged 50 to 79 years randomly assigned to 1,000 mg/day calcium and 400 IU (10 mcg)/day vitamin D supplements or placebo for 10 years found no reduction in risk of heart failure [69]. The American Journal of Clinical Nutrition 2007;86:1804-5. 11 Clinical Privileging Best Practices - HealthStream Depending on its strength, each chewable pill or soft chew provides about 270 to 400 mg of calcium [14]. Evidence on dose-response relationships between calcium intakes and risk of stroke or stroke mortality was inconsistent. A systematic review and meta-analysis of 41 RCTs that examined the effect of dairy foods or calcium supplements (at least 300 mg/day) in 4,802 adults found that higher calcium intakes from dairy foods had no impact on body weight or body fat, although they did reduce body fat when combined with an energy-restricted diet [91]. [, Jones BJ, Twomey PJ. Risk of heart failure among postmenopausal women: a secondary analysis of the randomized trial of vitamin D plus calcium of the women's health initiative. Health professional - Wikipedia Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%98%) healthy individuals; often used to plan nutritionally adequate diets for individuals. Defining Nutrient Requirements: Dietary Reference Intakes These documents are issued by the Food and Nutrition Board of theNational Academies of Sciences Engineering, and Medicine. Nutr Rev 2021. For example, a longitudinal cohort study of 1,490 women aged 42 to 52 years at baseline who were followed for 1012 years found that fracture risk was not significantly different in calcium supplement users (some of whom also took vitamin D supplements) and nonusers, even though supplement use was associated with less BMD loss throughout the study period [36]. [, Bove-Fenderson E, Mannstadt M. Hypocalcemic disorders. [, Singh N, Singh PN, Hershman JM. However, the quality of this evidence was low. A recommended dietary allowance (RDA) for a nutrient is derived from an estimated average requirement (EAR), which is an estimate of the intake at which the risk of inadequacy to an individual is 50%. Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects. While this data represents current scientific knowledge on nutrient needs, individual requirements may be higher or lower than the DRI recommendations. World J Gastroenterol 2016;22:4594-603. Nutrition for Nursing Mothers: Limited evidence for calcium supplementation in preeclampsia prevention: a meta-analysis and systematic review. At birth, the body contains about 26 to 30 g calcium. Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils. [, Hofmeyr GJ, Betran AP, Singata-Madliki M, Cormick G, Munjanja SP, Fawcus S, et al. In contrast, an analysis of baseline data from a randomized trial in Australia in 1,994 women older than 65 years whose average dietary calcium intake was 886 mg/day found no association between quintile of calcium intake and BMD at any site, even after adjustment for such factors as age, physical activity, height, and weight [31]. For example, calcium carbonate is 40% calcium by weight, whereas calcium citrate is 21% calcium [1]. [, Brunner RL, Wactawski-Wende J, Caan BJ, Cochrane BB, Chlebowski RT, Gass ML, et al. Introduction. [, Yang B, Campbell PT, Gapstur SM, Jacobs EJ, Bostick RM, Fedirko V, et al. [, Wallace TC, McBurney M, Fulgoni VL, 3rd. Br J Nutr 2015;114:1013-25. The small ionized pool of calcium in the circulatory system, extracellular fluid, and various tissues mediates blood vessel contraction and dilation, muscle function, blood clotting, nerve transmission, and hormonal secretion [1,2]. Dairy calcium intake, serum vitamin D, and successful weight loss. However, one value for each nutrient, known as the Daily Value (DV), is selected for the labels of dietary supplements and foods. [, Liu C, Kuang X, Li K, Guo X, Deng Q, Li D. Effects of combined calcium and vitamin D supplementation on osteoporosis in postmenopausal women: a systematic review and meta-analysis of randomized controlled trials. Individuals taking these and other medications on a regular basis should discuss their calcium status with their health care providers. Note: Work on the next edition of the Dietary Guidelines, 2025-2030 is currently under way. The development of the DRIs replaces the reports on Recommended Dietary Allowances (RDAs), issued periodically from 1941 to 1989 by the National Academy of Sciences, and Recommended Nutrient Intakes (RNIs), published by the Canadian government (Canada, 1990 . The American Journal of Clinical Nutrition 2008;87:792-. Similarly, an evidence report and systematic review conducted for the USPSTF that included 11 RCTs of vitamin D, calcium, or both for 2 to 7 years in 51,419 adults aged 50 years and older found that supplementation with vitamin D alone or combined with calcium had no effect on CVD incidence [39]. Multivitamin/mineral supplement contribution to micronutrient intakes in the United States, 2007-2010. Again, monitoring to assure that providers stay within the scope of what they have been granted is a CMS and accreditation requirement. In contrast, several prospective cohort studies and RCTs have shown that calcium supplements increase the risk of CVD. Br J Nutr 2016;116:286-93. The labels approved by the FDA for dolutegravir advise patients to take dolutegravir 2 hours before or 6 hours after taking calcium supplements [101,102]. More severe signs and symptoms can include renal calcification or injury, brain calcification, neurologic symptoms (e.g., depression and bipolar disorder), cataracts, congestive heart failure, paresthesia, seizures, and, in rare cases, coma [22,24]. J Clin Pharmacol 2015;55:490-6. This site is coordinated by the Office of Disease Prevention and Health Promotion. But when the analysis was restricted to trials with 4,000 or more women, the effect was no longer statistically significant. Results were similar in 698 of the women who were followed for 6 years, even though mean daily intakes of calcium dropped by an average of 40 mg during this period. A 4-year study of 1,500 mg calcium and 2,000 IU (50 mcg) vitamin D or placebo daily for 4 years in 2,303 healthy women aged 55 years and older showed that supplementation did not reduce the risk of all types of cancer [41]. Nutr Metab Cardiovasc Dis 2015;25:623-34. It is influenced by. Jama 1998;279:750. PLoS One 2020;15:e0235042. However, two subsequent systematic reviews of the evidence from 10 studies in more than 8,000 adults with osteoporosis who took 120 to 1,500 mg supplemental calcium daily for 3 days to 3 years [98] and 11 RCTs in 51,419 adults 50 years and older who took 1,000 to 1,600 mg calcium with or without vitamin D for 2 to 7 years [39] found no such association. U.S. Department of Agriculture, Agricultural Research Service. Lithium [, Khan B, Nowson CA, Daly RM, English DR, Hodge AM, Giles GG, et al. Heaney RP. Protein. Calcium - Health Professional Fact Sheet - Office of Dietary The prevalence of overweight or obesity at 6-year follow-up was lower in boys (16%) and girls (18%) in the highest tertile of calcium intake (664 mg/1,000 kcal for boys and 667 mg/1,000 kcal for girls) than in boys (26%) and girls (25%) in the lowest tertile (249 mg/1,000 kcal for both boys and girls). Nutr Rev 2006;64:S53-6. The risk of atherosclerosis over 10 years in a study of 5,448 adults aged 4584 years was 27% lower in the highest quintile of calcium intake (mean of 2,157 mg/day) than in the lowest quintile (mean of 313 mg/day) [64]. A diet containing more calcium than the typical U.S. diet because of added low-fat or non-fat dairy products lowered systolic blood pressure by an average of 5.5 mmHg and diastolic blood pressure by 3.0 mmHg [66]. Eur J Clin Nutr 2018;72:541-7. As with the evidence on the link between increased calcium intakes and reductions in BMD loss, the findings of research on the use of calcium supplementation to prevent fractures in older adults are mixed. SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. [, Han D, Fang X, Su D, Huang L, He M, Zhao D, et al. Intake and adequacy of the vegan diet. The Dietary Guidelines for Americans ( Dietary Guidelines ), 2020 - 2025 provides advice on what to eat and drink to meet nutrient needs, promote health, and prevent disease. Age- Adult men and women require nutrients for maintenance where as infants and children require it . Encyclopedia of Dietary Supplements. Updated: Approximately 22% of men, 32% of women, and 4 to 8% of children take a dietary supplement containing calcium [18]. Options for increasing calcium intakes in individuals with lactose intolerance include consuming lactose-free or reduced-lactose dairy products, which contain the same amounts of calcium as regular dairy products [1,3]. Levels of ionized (or free) calcium, the biologically active form, in serum are also used to measure calcium status. However, in subgroup analyses, calcium had no effect on femoral neck BMD. Calcium has the potential to interact with certain medications, and several types of medications might adversely affect calcium levels. FDA has approved a health claim for the use of supplements containing calcium and vitamin D to reduce the risk of osteoporosis [29]. A variety of foods and their calcium content are listed in Table 2. Nutrients 2021;13:368. In the United States, approximately 72% of calcium intakes come from dairy products and foods with added dairy ingredients [1]. DVs were developed by the U.S. Food and Drug Administration (FDA) to help consumers determine the level of various nutrients in a standard serving of food in relation to their approximate requirement for it. The total amount of potassium in the adult body is about 45 millimole (mmol)/kg body weight (about 140 g for a 175 pound adult; 1 mmol = 1 milliequivalent [mEq] or 39.1 mg potassium) [ 3 ]. Br J Nutr 2006;95:539-45. NHANES data from 2007 to 2014 show that the risk of inadequate calcium intakes (less than 800 to 1,100 mg) is 11.6% higher among adults aged 50 and older in households earning less than $20,000 per year than other households [20]. J Clin Endocrinol Metab 2019;104:3576-84. A systematic review of the evidence. A post-hoc analysis of data from a double-blind, randomized controlled trial (RCT) of 1,000 mg elemental calcium in the form of calcium carbonate and 400 International Units (IU) (10 microgram [mcg]) vitamin D3 daily or placebo in 36,282 women aged 5079 years enrolled in the Womens Health Initiative (WHI) found that the supplementation did not prevent height loss after a mean follow-up period of 5.9 years [32]. Calcium intake from diet and supplements and the risk of coronary artery calcification and its progression among older adults: 10-year follow-up of the Multi-Ethnic Study of Atherosclerosis (MESA). [, Booth AO, Huggins CE, Wattanapenpaiboon N, Nowson CA. For example, a meta-analysis of 8 RCTs in 30,970 adults older than 50 years found that 500 to 1,200 mg/day calcium and 400 to 800 IU/day (10 to 20 mcg/day) vitamin D supplementation for 1 to 7 years reduced the risk of total fractures by 15% and hip fractures by 30% [37]. The study also found no associations between consumption of dairy foods (milk, yogurt, and cheese) at age 13 and BMI at age 21. Sex - In general requirement is more for men than women. Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals. For each 300 mg/day increase in dietary calcium intake, risk of metabolic syndrome dropped by 7%. These levels remain constant in men, but they start to drop in women as a result of increases in bone remodeling due to decreased estrogen production at the start of menopause [1].