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Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997)
Institute of Medicine (IOM)

Page
413
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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride

Index

A

Achlorhydria, 74, 142

Adenylate cyclase, 191

Adequate Intakes (AIs), see also Calcium AIs;

Fluoride, AIs;

Vitamin D, AIs

applicable population, 22

criteria used to derive, 12-13

defined, 4, 6, 24, 25, 48, 301, 315, 317

derivation of, 4, 5-8, 32-33, 48-50, 317

discrepancies between usual intakes and, 324

extrapolation from other age groups, 26

gender and, 17, 34

increasing consumption of nutrients, 10-12, 28, 323

indicators used to set, 27, 40, 91, 261-263, 298-301

RDAs compared, 5-8, 26

replacement of, 25

safety factors, 8

uncertainty in, 317

uses, 4, 5, 11, 28, 317

Adolescents, 9 through 18 years.

See also Puberty

ages 9 through 13 years, 34, 41, 99-106, 169-173, 210-218, 268-269, 303;

see also Puberty

ages 14 through 18 years, 34, 99-106, 169-173, 179, 180, 186-187, 210-218, 219, 239, 240, 241, 303

Body Mass Index, 36

bone mass, 102, 104, 105

bone mineral content, 100, 101-102, 103, 133-134

bone mineral density, 100, 102, 103, 104-105

calcium, 41, 73, 75, 87, 99-106, 143, 144, 215, 324, 396

fluoride, 295, 296, 303

indicators used to set AIs, 100-105

indicators used to set EARs, 169-172, 210-212

lactation, 133-134, 179, 180, 241

magnesium, 194, 195, 206, 210-213, 214-215, 216-219, 240, 241, 244-246, 268

phosphorus, 154, 159, 165, 169-173, 177-178, 179, 180, 184-185, 186, 187-189, 321

pregnancy, 114, 177-178, 239, 240, 276

RDAs, 172-173, 218, 219, 239

supplements, 96-97, 215

ULs, 141-142, 188, 244-246, 285, 310-311

vitamin D, 262, 268-269, 276, 277, 284-285, 286

weights and heights, reference, 35-36

Adults, 19 through 30 years

Body Mass Index, 36, 37

bone mass, peak, 34, 106-107

calcium, 75-76, 87, 106-109, 111, 397

derivation of DRIs for, 34-35

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413

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride Index A Achlorhydria, 74, 142 Adenylate cyclase, 191 Adequate Intakes (AIs), see also Calcium AIs; Fluoride, AIs; Vitamin D, AIs applicable population, 22 criteria used to derive, 12-13 defined, 4, 6, 24, 25, 48, 301, 315, 317 derivation of, 4, 5-8, 32-33, 48-50, 317 discrepancies between usual intakes and, 324 extrapolation from other age groups, 26 gender and, 17, 34 increasing consumption of nutrients, 10-12, 28, 323 indicators used to set, 27, 40, 91, 261-263, 298-301 RDAs compared, 5-8, 26 replacement of, 25 safety factors, 8 uncertainty in, 317 uses, 4, 5, 11, 28, 317 Adolescents, 9 through 18 years. See also Puberty ages 9 through 13 years, 34, 41, 99-106, 169-173, 210-218, 268-269, 303; see also Puberty ages 14 through 18 years, 34, 99-106, 169-173, 179, 180, 186-187, 210-218, 219, 239, 240, 241, 303 Body Mass Index, 36 bone mass, 102, 104, 105 bone mineral content, 100, 101-102, 103, 133-134 bone mineral density, 100, 102, 103, 104-105 calcium, 41, 73, 75, 87, 99-106, 143, 144, 215, 324, 396 fluoride, 295, 296, 303 indicators used to set AIs, 100-105 indicators used to set EARs, 169-172, 210-212 lactation, 133-134, 179, 180, 241 magnesium, 194, 195, 206, 210-213, 214-215, 216-219, 240, 241, 244-246, 268 phosphorus, 154, 159, 165, 169-173, 177-178, 179, 180, 184-185, 186, 187-189, 321 pregnancy, 114, 177-178, 239, 240, 276 RDAs, 172-173, 218, 219, 239 supplements, 96-97, 215 ULs, 141-142, 188, 244-246, 285, 310-311 vitamin D, 262, 268-269, 276, 277, 284-285, 286 weights and heights, reference, 35-36 Adults, 19 through 30 years Body Mass Index, 36, 37 bone mass, peak, 34, 106-107 calcium, 75-76, 87, 106-109, 111, 397 derivation of DRIs for, 34-35

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride energy expenditure, 34-35 fluoride, 289, 303 indicators used to set AIs, 107-108, 269-270 indicators used to set EARs, 173-174, 219-221 lactation, 179, 241 magnesium, 219-223, 239, 241, 244-246 phosphorus, 173-175, 177-179, 186-187, 188-189 RDAs, 173, 175, 179, 223, 239 ULs, 137-141, 186-187, 244-246, 281-283, 310-311 vitamin D, 269-271, 281-283 weights and heights, reference, 36 Adults, 31 through 50 years calcium, 109-110, 398 derivation of DRIs for, 34-35 energy metabolism, 35 fluoride, 303 indicators used to set AIs, 109-110, 269-270 indicators used to set EARs, 173-174, 223-226 lactation, 179, 241 magnesium, 207, 223-228, 239, 241, 244-246 phosphorus, 173-175, 177-179, 186-187 RDAs, 175, 179, 228, 239 ULs, 137-141, 186-187, 244-246, 281-283, 310-311 vitamin D, 269-271, 281-283 Adults, 51 through 70 years bone loss, 271-272 bone mineral density, 112, 113-114 calcium, 111-115 derivation of DRIs for, 35 energy expenditures, 35 fluoride, 303 indicators used to set EARs, 228 indicators used to set AIs, 111-114, 271-272 magnesium, 228-231, 244-246 phosphorus, 154, 175-176 RDAs, 176, 231 ULs, 137-141, 186-187, 244-246, 281-283, 310-311 vitamin D, 263, 271-272, 281-283 Adults, +70 years bone mineral density, 116 calcium, 87-88, 115-117, 142 fluoride, 303 fracture rates, 115-116 indicators used to set AIs, 115-116, 231-232, 273-274 magnesium, 195, 200, 201-202, 203, 204, 207, 231-234, 245 phosphorus, 154, 175-176, 188 RDAs, 176, 233-234 ULs, 142, 188, 244-246, 281-283, 310-311 vitamin D, 255, 273-274, 287 Adverse effect, 52, 63 African Americans blood pressure, 89 bone mass, 73 bone mineral content, 97 bone fractures, 73, 90 calcium, 73, 80, 89, 100 lactose intolerance, 80 magnesium, 195 phosphorus, 149 puberty, 34 vitamin D, 260, 263, 269, 270 Alcohol consumption and alcoholism, 157, 191, 193, 200, 203, 204, 206, 207 Aluminum, 148, 157, 219, 243, 245 American Academy of Pediatrics, 32, 33, 295, 305 American Dental Association, 295, 304, 305 Anemia, 157 Animal studies extrapolation of data from, 54, 57, 62-63 relevance of, 63, 65-66 Anorexia, 157, 280 Antacids, 139, 148, 157, 243, 245 Asians blood pressure, 89 calcium, 89, 98 magnesium, 200 osteoporosis, 83, 200 vitamin D, 264, 266 Atherosclerosis, 198, 249 Athletes, 188, 195, 316 B Balance studies. See also Calcium balance studies adolescents, 169, 212, 214-215 adults, 228, 229, 271 calcium, 314 children, 164, 168, 211-212

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride fluoride, 289, 300-301, 304 infants, 161, 208-209 lactating women, 17, 240-241 magnesium, 17, 40-41, 192, 204-205, 208-209, 211-212, 214-215, 218, 219-221, 223-227, 228, 229, 231, 234, 240-241, 245, 249 methodological considerations, 40-41, 42, 50, 88 older adults (+70), 231 phosphorus, 9, 40, 154, 158, 161, 164, 166-167, 168, 169, 171, 176-177 young adults, 219-221 Bioavailability of nutrients calcium, 47-48, 59, 61, 73-74, 80, 94-95 cross-cultural differences in, 47-48 defined, 60, 69 factors affecting, 59, 60-62, 73-74, 151-154 fluoride, 291 from infant formula, 94-95 magnesium, 193, 205, 210, 238 phosphorus, 151-152, 153 and risk assessment, 59, 60-62, 66 from supplements, 62, 74 vegetarian diets and, 80 Bisphosphonate, 278 Blood pressure, 199-200. See also Hypertension Body mass. See Lean body mass Body Mass Index, 36 Bone biologically significant nutrients, 38-39, 288-289 collagen by-products, 258 malignancy, 278 matrix proteins, 38-39 metabolism, 41, 38-39, 71, 99-100, 120, 144, 201, 254, 257-258, 284-285 pain, 157 remodeling, 41, 71, 86-87, 88, 102, 114, 289 Bone fracture calcium and, 6, 9, 13, 76, 83, 84-85, 90, 112-113, 115-116, 121, 123, 126-127, 144, 314-315 fluoride and, 300 gender differences, 90 hip, 47-48, 76, 83, 85, 121, 127 lactation and, 123, 126-127 older adults, 115-116 osteoporotic, 9, 47-48, 83, 84-85 predictors of risk, 85 race/ethnicity and, 73, 83, 84-85, 90 vitamin D and, 260, 273, 274 Bone loss caffeine and, 76 calcium intakes and, 75, 76, 77-80, 82-83, 87-88, 112 lactation and, 122 menopausal status and, 77-80 sodium and, 75 vitamin D and, 271-272 Bone mass adults, 86, 105, 106-107 calcium intake and, 13, 15, 74, 85-87 children, 85, 89 fluoride and, 307 and fractures, 13 gender and, 106-107 measurements, 9, 85-86, 89, 102, 104 peak, 34, 86, 87, 102, 106-107, 259 physical activity and, 74-75 race/ethnicity and, 73 vitamin D and, 259, 263-264, 271-272, 278 Bone mineral content (BMC) and body weight, 97 calcium, 6, 7, 9, 15, 38, 78-79, 97-98, 100, 101-102, 103, 106-107, 144 children, 97-98 defined, 85 fluoride, 38, 288, 300, 307 infants, 95 magnesium, 38, 200 phosphorus, 38, 68, 146, 151, 153, 161, 163, 164, 170, 189 race/ethnicity and, 97 vitamin D and, 38, 260, 266 young adults, 106-107 Bone mineral density (BMD) in adults, 110, 112, 113-114 caffeine and, 76 calcium and, 6, 9, 71, 74 76, 78-79, 80-81, 102, 103, 104-105, 110, 112, 113-114, 116, 120-121, 123, 126-129, 132, 144 defined, 85 lactation and, 123, 126-129, 132 magnesium and, 200, 201 pregnancy and, 127, 132 research recommendations, 189

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride vegetarian diets and, 80-81 vitamin D and, 14, 260, 261, 264, 271-272, 274 Boron, 38, 39 Breastfeeding. See also Human milk; Lactation recommendation, 25, 32, 208 twins, 132-133 British Paediatric Association, 284 C Caffeine, 76, 144, 291, 294 Calcification of tissues, 136, 180, 183, 184-185, 187, 198, 280, 281, 300, 307 Calcitonin, 193 Calcium absorption, 72-73, 76, 77, 85, 92, 93, 94-96, 97, 100, 104, 115, 117, 120, 122, 123, 124-125, 126, 134, 135, 141, 142, 147, 154, 180, 185-186, 250, 254, 255, 275 accretion, 6, 7, 9, 15, 87, 92-93, 95, 97, 98, 99, 107, 111, 120 adolescents, 49, 71, 75, 99-106, 215 bioavailability, 59, 61 data availability, 90-91 estimating requirements for, 84-91; see also Calcium AIs excretion, 72-73, 75, 76 80, 96-97, 104, 111, 120, 122, 126, 136 intakes, see Calcium intakes interactions with other nutrients, see Calcium interactions intervention studies, 97-98, 110 kinetic studies, 182-183 metabolism, 48, 73, 87, 134, 259, 261; see also Calcium balance studies physiological role, 71 research recommendations, 13, 144-145 supplements, 45-46, 74, 77-80, 82, 86, 89, 97-98, 102, 110, 112, 114, 116, 120-121, 123, 126, 130-131, 134, 135, 137, 138, 213, 318, 324 Tolerable Upper Intake Levels, see Calcium ULs uncertainty factor, 68 Calcium AIs adolescents, 99-106, 118-119, 122, 133-134, 324 adults, middle age, 109-115, 118-119 balance studies, 6-7, 9, 15, 48-50, 93-94, 96-97, 98, 100-101, 107-108, 109-110, 111-115, 314-315 biochemical and absorption studies, 124-125 bone mass measurements and, 85-87 bone mineral content, 95, 97-98, 100, 101-102, 103, 117, 118-119, 122, 133-134 bone mineral density and, 110, 116, 117, 118-119, 120-121, 123, 126-131 calcium accretion and, 92-93, 97, 98, 99, 100, 102, 107 calcium retention and, 87-89, 93, 99, 100-101, 104, 105, 107-108, 109-110, 394-398 for children, 12, 75, 96-99, 118-119 chronic disease risk and, 89-90, 99 clinical trials, 6, 7, 48, 49, 101-102, 103, 104, 105, 119, 123 cross-cultural considerations, 47 derivation, 6-7, 41, 48-50, 96-97; see also Calcium balance studies; Calcium retention discrepancies between usual intakes and, 324 epidemiological evidence, 104-105 factorial approach, 6, 15, 48, 49, 102, 104, 105, 108, 109, 110-111, 118-119 fracture risk, 84-85, 115-116, 123, 126-127 gender differences, 71, 75, 99-100, 104, 107, 109, 111-115, 388-389 human milk intake and, 92 indicators used to set, 9, 84-91, 91-94, 96-98, 100-105, 107-108, 109-114, 115-116, 117, 120-121, 123, 126-127, 137, 314-315 infants, 71, 91-96, 183 lactation and, 122-134 by life-stage group, 12, 15, 91-134, 388-389 older adults (70+), 12, 115-117, 118-119, 127 physical activity and, 74-75, 76 pregnancy and, 12, 15, 20, 72, 89-90, 117, 120-122, 127, 132 puberty and, 49, 71, 99-100 racial/ethnic differences, 73, 100 sexual maturity and, 99-100 special considerations, 115, 127, 132 young adults, 108-109, 111

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride Calcium balance studies, 215, 314 AI derivation, 6-7, 9, 15, 48-50, 93-94, 96-97, 100-101, 105, 107-108, 109-110, 111-115 adults, middle age, 109-110, 113, 114 bone mass measurements and, 86 children, 96-97, 98 infants, 92, 93-94 methodological considerations, 40-41, 50, 88 pregnancy, 120 protein interaction, 75-76 research recommendations, 144-145 uncertainties in values from, 7, 50, 91 young adults, 75-76, 107-108, 109 Calcium deficiency, 182, 183 amenorrheic women, 76 and bone loss, 75, 76, 77-80, 82-83, 132-133 and fractures, 6, 9, 13, 76, 83, 84-85, 90, 112-113, 115-116, 121, 123, 126-127, 314-315 lactose intolerance and, 80 and osteopenia, 83 and osteoporosis, 9, 47-48, 76, 82, 83, 84-85, 113, 115 and prostate cancer, 13 Calcium for Preeclampsia Prevention trial, 89-90 Calcium intakes and absorption of calcium, 71, 72, 97, 100 adolescents, 105-106, 194, 324, 396 adults, middle age, 194, 398 bioavailability, 47-48, 73-74, 80, 92 and bone mass, 13, 15, 74, 85-88, 106-107 and bone mineral content, 6, 7, 15, 38, 78-79, 98 and bone mineral density, 74, 76, 78-79, 80-81, 112 and calcium retention, 111-112, 114 children, 99, 136 and colon cancer, 90 and chronic disease risk, 89-90, 99 cross-cultural differences, 47-48, 82 disappearance data, 45 experimentally derived, 7, 100-101 food and water sources, 45, 47, 73-74, 80, 81-82, 110, 318, 324 and fracture risk, 84-85, 90 gender differences, 44, 81, 82, 105-106, 117, 388-389 human milk, 91-94 and hypertension, 89-90 inadequate, see Calcium deficiency increasing, strategies for, 324 lactation and, 127 lactose intolerance and, 80 by life-stage group, 43, 44, 81-82, 388-389 menopausal status and, 72, 75, 76, 77-81, 112-113, 201 older adults (+70), 117 plateau, 87, 101, 108, 109-110, 115, 116, 394 pregnancy and, 121-122 quality of data, 100 vegetarian diets and, 80-81 young adults, 75-76, 106-107, 109, 397 Calcium interactions, 59, 68, 152-154, 195 boron and, 38, 39 caffeine, 76 chloride, 61 dietary fiber, 135 estrogen, 76, 77, 88, 113, 115, 126 fluoride, 288, 289, 290, 291 iron, 137, 140, 141, 142 magnesium, 135, 137, 142, 191, 194, 197, 200, 201, 213, 214-215, 225, 229, 239 parathyroid hormone, 72, 73, 75, 82-83, 117, 120, 132 phosphorus, 61, 135, 137, 151, 152-154, 156, 158, 160-161, 174, 176, 178, 180, 181-184, 185-186 protein, 48, 61, 75-76, 135 sodium, 48, 61, 75, 135 vitamin D, 14, 38, 39, 77, 83, 85, 116, 117, 122, 132, 250-253, 254, 255, 258-263, 264, 265, 273, 274, 275, 278, 281-282, 285, 286, 287 zinc, 137, 140, 141, 142 Calcium-regulating hormones, 181-184 Calcium retention adolescents, 87, 99, 100-101, 104, 105, 117, 118-119, 396 adults, middle age, 109-110, 111-112, 398 AI derivation, 87-89, 93, 99, 100-101, 104, 105, 107-108, 394-398 bone mass measurements, 85-86

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride calcium intakes and, 111-112, 114 children, 85-86, 96-97, 99 desirable, 6-7, 15, 48-49, 87-88, 91, 107-108, 110, 111-112, 117, 118-119, 144, 314-315, 394-398 extrapolation from other age groups, 15 factors affecting, 49, 71, 72, 87 gender differences, 111-114, 118-119 infants, 92, 94, 96 methodological considerations, 41 older adults, 87, 115-116 plateau, 112, 114 pregnancy and, 120 protein and, 75-76 young adults, 87, 107-108, 397 Calcium ULs, 13, 20, 318. See also Calcium interactions adults, 137-141 children, 136, 141-142, 143 critical endpoint, 137-138, 140 data selection, 137-138 derivation of, 140-141 dose-response assessment, 68, 137-143 exposure assessment, 143 gender differences, 135 hazard identification, 134-137 infants, 141 and milk-alkali syndrome, 136-137, 138, 139, 140-141 and nephrolithiasis (renal stones), 13, 68, 134-136, 137, 138 NOAEL/LOAEL, 137-138, 140 older adults (70+), 142 pregnancy and lactation, 142 risk characterization, 143 special considerations, 142-143 supplements, 137-138, 143 uncertainty assessment, 140 Canada bone mineral content in adolescents, 170 dietary intake data, 43, 47, 81, 292-293 fluoride, 292-293, 295, 302, 305, 312 magnesium standards, 30 osteoporosis, 83 phosphorus standards, 31 reference nutrient values, 29-31 weights and heights, reference, 36 Canadian Paediatric Society, 32, 33, 295, 305 Cancer. See individual sites Cardiovascular diseases, 9, 144 fluoride and, 300, 310 magnesium and, 14, 191, 197-200, 203, 204, 207, 222, 243, 247 vitamin D and, 281 Caucasians blood pressure, 89 bone fracture in, 73, 90 bone mineral content, 97 calcium, 89, 97 lactose intolerance, 80 magnesium, 195, 199 osteoporosis, 83 phosphorus, 149 vitamin D, 260, 263, 270, 272 Children, ages 4 through 8 years. See also Life-stage groups; Toddlers balance studies, 164, 168, 211-212 blood pressure, 89 bone mass, 85-86, 88 bone mineral accretion, 14, 88, 89, 97-98 calcium, 14, 46, 73, 74, 75, 82, 85-86, 88, 89, 96-99, 136, 141-142, 143, 144 chronic illness, 99 derivation of DRIs for, 34, 37 fluoride, 289, 290, 291-292, 293, 294-296, 298-299, 301, 303, 304, 305, 306, 308-309, 311-312 growth spurts, 14 indicators used to set AIs, 96-98, 266-267 indicators used to set EARs, 166-168, 210-212 magnesium, 14, 30, 41, 46, 196, 205-206, 210-212, 213, 216, 246, 247-248 phosphorus, 14, 30, 31, 46, 149, 156, 158-159, 164, 166-169, 186, 187 physical exercise, 74 sodium, 75 supplements, 46, 82 vitamin D, 14, 46, 257-258, 259, 260, 262-263, 266-268, 284-285 weights and heights, reference, 35-36, 37 Cholecalciferol, 250, 251, 252, 255, 256, 259, 271 Chromium, 66 Chronic disease. See also specific diseases risk reduction as indicator of nutrient adequacy, 8, 40 Collagen cross-linking, 38, 75-76 Colon cancer, 90, 258 Constipation, 136

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride Continuing Survey of Food Intakes by Individuals, 42, 43, 387 calcium intakes, 81, 109, 115, 117, 121-122, 127, 143, 388-389 magnesium intakes, 195, 216, 217-218, 219, 222, 227, 230-231, 238, 239, 241-242, 392-393 phosphorus intakes, 154, 163, 166, 168, 172, 174-176, 177-178, 184, 188-189, 321, 390-391 Copper, 38, 59, 180-181, 189 Coronary artery disease, 247 Critical endpoint calcium, 137-138, 140 defined, 66 fluoride, 308-309 magnesium, 244-245 phosphorus, 186-187 vitamin D, 68, 281-282, 283-284 Cross-cultural differences. See Race/ethnicity D Dairy products calcium, 47, 73, 74, 80, 81-82, 89, 110, 143 fortified, 256, 261-262 lactose intolerance, 80 magnesium, 200 phosphorus, 156 vitamin D, 268, 269 Data and database issues availability of data, 68, 167, 169, 175 critical data set, 66 for dose-response assessment, 281, 283 for hazard identification, 62-63 human studies, 62, 65 magnesium, 244 phosphorus, 68, 167, 169, 175 quality and completeness of, 64 selection for dose-response assessment, 65-66, 244 uncertainties in, 54, 58 vitamin D, 281, 283 Dental caries, 8, 19, 288-289, 290, 291, 297-300, 301, 302, 313 Dental products, fluoride in, 45, 291, 295-296, 300, 311-312, 318 Diabetes mellitus calcium and, 99 magnesium and, 14, 191, 200, 201-202, 203, 204, 207, 239-240 phosphorus and, 157 Diarrhea, 157, 242, 243, 244-245, 318 Diet and Health report, 8, 40, 63 Dietary fiber, 127, 192, 193, 199, 219, 221, 223, 224, 226, 229 Dietary intakes. See also Supplements; specific nutrients adjustment of, 319-323 and bioavailability, 61 breast-fed infants, 93-94 cross-cultural differences, 47-48 disappearance data, 45, 155 fluoride, 291-296, 301, 308-309 food composition databases, 42-43, 262 form of, 62, 63 n.1 gender differences, 387-393 self-reported, 42, 43, 81, 319 sources of data, 43-44 uses of data, 47 Dietary Reference Intakes (DRIs) applicable population, 22 assessment applications, 10, 11, 21, 314, 316-317, 319-322 categories; 2-5, 6, 23-27; see also Adequate Intakes; Estimated Average Requirements; Recommended Dietary Allowance; Tolerable Upper Intake Levels country reference values compared, 28-31 criteria for, 9-10, 21-22, 38 defined, 21-22, 37 dietary intakes compared, 43 extrapolation from other age groups, 33 framework, 378-379 generalizability to other populations, 2, 47 group applications, 11, 317, 319-323 individuals applications, 11, 315-317 international application, 2, 10 by national and federal agencies, 323 origin, 375-376 parameters for, 31-37; see also Life-stage groups; Reference weights and heights planning applications, 11, 21, 314, 322-323 rationale for, 376-378 sources of data, 9-10, 39-40; see also Methodological considerations

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride uses, 10, 11, 21, 27-28, 47, 314-317, 319-323 WHO/FAO/IAEA approach compared, 22 1,25-Dihydroxyvitamin D, 260 biologic role, 250-253, 255 calcium regulation, 38, 77, 117, 120, 122-123, 132, 250 and granulomatous diseases, 255, 285 half-life, 254 and hypercalcemia, 255 and hypercalciuria, 255 and hypervitaminosis D, 278 and hypovitaminosis D, 258, 268 as indicator of vitamin D status, 260 lactation and, 122-123, 132 magnesium and, 192, 197 metabolism, 251, 254-255 phosphorus and, 38, 147-148, 151, 176, 181, 250, 254 pregnancy and, 117, 120, 276 puberty and, 268, 269, 286 24,25-Dihydroxyvitamin D, 254 Diuretics, 142, 193, 198 Dose-response assessment adolescents, 187-188, 244-246, 310-311 adults, 137-141, 186-187, 281-282, 310-311 calcium, 68, 137-143 children, 187, 284-285, 308-309 components and process, 55, 57, 65-69 critical endpoint, 66, 137-138, 140, 186-187, 244-245, 308-309 data selection, 65-66, 137-138, 244, 281, 283, 308, 309, 310 derivation of UL, 68, 282-283, 309, 310-311 fluoride, 68, 308-311 infants, 187, 283-284, 308-309 lactation, 188, 285, 311 magnesium, 68, 244-247 NOAEL/LOAEL identification, 66, 137-138, 140, 186-187, 244-245, 281-282, 283-284, 308-309, 310 older adults, 188 phosphorus, 68, 186-187 pregnancy, 188, 285, 311 special considerations, 68-69, 285 toddlers, 187, 308-309 uncertainty assessment, 66-68, 187, 245, 282, 284, 309, 310 vitamin D, 68, 281-285 Drinking water calcium in, 198 fluoride in, 45, 291-292, 293, 295, 297-300, 301, 305, 307, 308, 310, 312-313, 318 magnesium in, 196, 198, 205 Dual-energy x-ray absorptiometry, 9, 85, 89, 97, 102, 104, 164 E Early childhood. See Children, ages 4 through 8 years Education of consumers, 10, 28, 323 Elderly people. See Adults, +70 years Enamel fluorosis, 298-299, 300-302, 305-307, 308-309, 311-313, 318 End-stage renal disease, 151, 184-185, 186 Energy metabolism, 9, 12, 20, 23, 24, 28, 29, 34-35, 190, 205, 212, 316 Environmental exposures to dietary agents, 53, 58 Ergocalciferol, 250, 257, 259 Estimated Average Requirements (EARs). See also individual nutrients coefficient of variation, 3, 322-323 country comparisons, 29 defined, 2-3, 6, 23, 24, 315 derivation of, 3, 13, 40 indicators used to set, 27, 158-159, 164-166 and RDA, 3-4, 23-25, 26 standard deviation, 3 uses, 3, 10, 11, 23, 24, 25, 319-323 Estrogen and calcium, 76, 77-80, 88, 109-110, 115, 126 and magnesium, 201 Ethnic background. See Race/ethnicity Exposure duration of, 64 route of, 63, 66 Exposure assessment calcium, 143 fluoride, 311-312 magnesium, 247-248 phosphorus, 188-189 process, 55, 57-58 vitamin D, 285-286

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride F Factorial approach calcium, 6, 7, 48, 49, 102, 104, 105, 108, 109, 110-111 phosphorus, 16, 40, 164-166, 168, 170, 172 Fetal calcium needs, 117 growth retardation, 234, 235-237 sensitivity to nutrients, 60, 303-304 Fiber. See Dietary fiber Fluorhydroxyapatite, 288 Fluoride absorption, 289, 291, 313 adolescents, 295, 296, 303 adults, 289, 293, 296, 301, 303 AIs, 8, 14, 19, 40, 50, 298-300, 301-306 balance studies, 289, 300-301, 304 bioavailability, 291 and bone mineral content, 38, 288, 300, 307, 310 and caffeine, 291, 294 and calcification of tissues, 300, 307, 313 and calcium, 288, 289, 290, 291 children, 289, 290, 291-292, 293, 294-296, 298-299, 301, 303, 304, 305, 306, 308-309, 311-312 and dental caries, 8, 14, 19, 50, 288-289, 290, 297-300, 301, 302, 313 in dental products, 45, 291, 295-296, 300, 307, 311-312, 318 derivation of DRI, 8, 40, 50 in drinking water, 45, 291-292, 293, 295, 297-300, 301, 305, 307, 308, 310, 318 and enamel fluorosis, 298-299, 300-302, 305-307, 308-309, 311-313, 318 excretion, 289-290, 313 factors affecting nutrient requirement, 291 food sources, 291, 293-294 gender differences, 19, 303 and geographic differences, 298-300, 307-308 in human milk, 19, 291, 292, 301, 302, 305, 306, 311 indicators of nutrient requirements, 19, 40, 298-301 infants, 290, 293, 295, 300, 301-302, 304, 305-306, 309, 311, 312 intakes, 45, 291-296, 301, 306, 308 interactions with food components, 291 international comparisons, 298-300 lactation and, 12, 19, 305-306 life-stage group and, 19, 301-306 menopausal status and, 300 metabolism, 289-290, 305 and osteoporosis, 288, 300, 307 and osteosclerosis, 307, 308, 310 phosphate, 290 physiological role, 288-289 pregnancy and, 12, 19, 303-305 research recommendations, 14, 313 skeletal fluorosis, 307-308, 310-311 sources of, 45, 318 special considerations, 305-306, 311 supplements, 295, 298-299, 302, 304, 311-312 sustained release form, 288 toddlers, 293, 302-303, 309 toothpastes, 291, 295-296, 300 ULs, 13, 20, 68, 306-313, 318 uncertainty factor, 68, 310 young adults, 289 Food additives, 57, 154, 155, 180, 189 Food and Agriculture Organization, 22, 52, 319, 322 Food composition databases, 42-43 Food sources calcium, 45, 47, 81-82 fluoride, 291, 293-294 magnesium, 193, 196, 199-200 phosphorus, 151-152, 155-156, 161, 173-174, 180, 181, 183-184, 189 vitamin D, 256-257, 261-262, 268, 269, 270, 271, 283, 284, 285-286 Formulas, infant bioavailability of nutrients from, 32, 94-95, 96, 210 calcium, 94-96, 141 fluoride in, 291, 292, 293, 301-302, 306 magnesium, 210 phosphorus, 149, 152, 153, 155, 159, 161, 163, 183 special considerations, 163, 210, 265 vitamin D, 257, 262, 265, 266 Fortified foods, 4, 10-11, 12, 26, 28, 59, 143, 256, 261-262, 283, 284, 285-286, 318. See also Formulas, infant Fracture. See Bone fracture Fruits and vegetables, 82, 193, 196, 199-200, 229

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride G Gender differences. See also Men; Women bone fracture rates, 90 bone mass, peak, 106-107 calcium, 44, 46, 81, 82, 99-100, 104, 106, 107, 109, 388-389 extrapolation between groups, 90-91 fluoride, 12, 19, 303 magnesium, 12, 17, 46, 196, 199, 214-215, 216-231, 392-393 phosphorus, 46, 154, 155, 156, 168, 172-173, 174-176, 390-391 puberty onset, 34 supplement intakes, 46, 82 vitamin D, 14, 256, 257, 269, 271, 272, 274 Geographic variables fluoride, 298-300, 307-308 vitamin D, 14, 259, 264-267, 269-270, 271, 273, 274, 281, 284, 286 Glomerular filtration rate (GFR), 27, 149, 150, 160, 175, 184-185, 280, 289 Grain products, 73, 81-82, 152, 161, 173, 193, 195, 256 Growth factors, 191 linear, 263-264, 283 magnesium and, 205-206 phosphorus and, 169-170, 172 velocity, 169-170, 172 vitamin D and, 263-264, 283 H Hazard identification, 69 calcium, 134-137 components of, 62-64, 65 evaluation process, 55, 57, 63-64 fluoride, 306-308 magnesium, 242-244 phosphorus, 180-186 vitamin D, 277-281 Health Canada, 1 Height. See Reference weights and heights Hispanics blood pressure, 89 bone mineral content, 97 calcium, 89, 97 magnesium, 195-196 vitamin D, 260 Hormones, calcium-regulating, 181-184 Human milk. See also Breastfeeding; Lactation bioavailability of nutrients, 88 calcium, 15, 91-94 fluoride, 19, 291, 292, 301, 302, 305, 311 magnesium, 17, 208, 240 phosphorus, 16, 148, 149, 152, 153, 155, 160-163, 178, 183 vitamin D, 262, 263, 264, 265-266, 276-277 Hydroxyapatite, 71, 147, 151, 153, 200, 288 25-Hydroxyvitamin D AI indicator, 8, 18, 27, 50 and bone mass, 263-264, 273 and granulomatous diseases, 285 half-life, 254 and hypervitaminosis D, 277-278, 285 and hypovitaminosis D, 259-260, 263-277 lactation and, 276-277 and linear growth, 263-264 and magnesium, 192, 197 metabolism, 251, 253 normal range, 286-287 parathyroid hormone and, 259-260 placental transfer, 276 and pregnancy, 275-276 and puberty, 286 Hypercalcemia, 134, 136, 137, 138, 141, 182, 192, 255, 278, 280, 281-283, 284, 285 Hypercalciuria, 120, 135, 138, 140, 141, 255, 318 Hyperlipidemia, 247, 249 Hypermagnesemia, 192, 243-248 Hyperparathyroidism, 84, 136, 193, 258, 270, 273, 274, 278, 280 Hyperphosphatemia, 148, 151, 158, 180-189 Hypertension, 9 calcium intake and, 89-90, 144 magnesium and, 14, 199-200, 207, 234-237, 244, 249 preeclampsia, 89-90, 234, 235-238, 244 Hypervitaminosis D, 184-185, 186, 256, 277-287 Hypocalcemia, 96, 182, 183, 197, 239 Hypomagnesemia, 191, 193, 195, 197-203, 206, 235, 239, 249 Hypoparathyroidism, 193 Hypophosphatemia, 156-157, 158 Hypovitaminosis D, 253, 254, 257-258, 259, 263-264, 267, 271

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride I Immune system, 152, 157 Indicators of nutrient adequacy. See also specific indicators, nutrients, and life stages deficiency-based, 8-9 methodological considerations, 39-40 risk reduction-based, 8-9, 40 Infants, premature, 95, 122, 208, 236 Infants, 0 to 12 months. See also Formulas, infant; Human milk accretion of nutrients, 161 ages 0 through 6 months, 32-33, 48, 93-94, 163, 209, 263-265, 301-302 ages 7 through 12 months, 33, 94, 161, 162-163, 209, 265-266, 302 AI derivation for, 4, 5, 25, 26, 31-33, 40, 48, 91-96, 162-163, 209, 264-265, 266 balance studies, 161, 208-209 bone mass, 263-264 breast-fed, 4, 5, 32, 48, 91-94, 160, 183, 208, 263 calcium, 72, 91-96, 120, 122, 141, 183 country comparison of groups, 29 fluoride, 290, 293, 295, 300, 301-302, 304, 305, 306, 309, 311, 312 formula-fed, 141, 265 indicators used to set AIs, 160-161, 208-209, 263-266 linear growth, 263-264 low birth weight, 122, 235, 265 magnesium, 206, 208-210, 234, 235, 236, 243, 246 phosphorus, 32, 146, 148-149, 152, 153, 155, 157, 158-159, 160-163, 176-177, 183, 186-187 sensitivity to nutrients, 60 serum inorganic phosphorus, 160-161 serum 25(OH)D, 263-266 solid foods, 33, 94, 96, 141, 161, 162, 209 ULs, 141, 187, 246, 283-284, 308-309 vitamin D, 68, 259, 260, 262-266, 269-270, 275, 277, 283-284 Insulin, 191, 232 Interactions. See Nutrient-nutrient interactions International reference values comparison, by country, 28-31 fluoride comparisons, 298-300 generalizability of DRIs, 10 magnesium, 30, 209, 234-235 phosphorus, 30 Intracellular magnesium, 17, 203-204, 232, 234 Iron, 59, 61, 64, 66, 137, 140, 141, 142, 180-181, 189 J Japanese-American women, 85, 200 Joint FAO/WHP Expert Commission on Food Additives, 56-57 K Kinetic studies, 182-183 L Lactation. See also Breastfeeding; Human milk adolescents, 133-134, 179, 180, 241 balance studies, 17, 240-241 biochemical and absorption studies, 124-125 and bone fracture, 123, 126-127 and bone loss, 122, 132-133 and bone mineral density, 126-132 and bone mineral mass, 15, 123, 126-127 calcium and, 15, 122-134, 142 derivation of DRIs for, 35 fluoride and, 19, 305-306 indicators used to set AIs, 123, 126-127, 276-277 indicators used to set EARs, 178, 240-241 magnesium and, 17, 240-242, 247 phosphorus and, 16, 178-180, 188 and serum inorganic phosphate, 178 serum 25(OH)D, 276-277 twins/multiple infants, 180, 242 ULs, 142, 188, 246-247, 285, 311 vitamin D, 18, 122-123, 276-277, 285 Lactose intolerance, 80, 260 Lean body mass, 17, 59-60, 170, 211, 217, 238, 316 Life-stage groups. See also Adolescents; Adults; Children; Infants; Toddlers Body Mass Index by, 36 calcium, 15, 388-389 categories, 31-35, 60

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride and derivation of DRIs, 31-35 fluoride, 19, 301-306 intakes of nutrients by, 44 international comparisons, 28-30 magnesium DRIs by, 17, 208-242, 392-393 phosphorus, 16, 160-180, 390-391 vitamin D, 18, 263-277 weights and heights, reference, 35-37 Liver failure, 99, 255 Lowest-Observed-Adverse-Effect Level calcium, 137-138, 140 defined, 57 identification of, 66 intake data and, 47 fluoride, 308-309, 310-311 magnesium, 244-245 phosphorus, 186-187 and UL derivation, 68 uncertainty factor, 67-68 vitamin D, 281-282, 283-284 Lymphoma, 255, 278 M Magnesium absorption, 192, 193-194, 195, 202, 210, 218, 238, 242-243, 245 accretion, 205-206, 211, 222, 238 adolescents, 194, 195, 206, 210-213, 214-215, 216-219, 240, 244-246, 268 adults, 194, 206, 207, 219-231, 244-246 AIs, 17, 209 and alcoholism, 191, 193, 200, 203, 204, 206, 207 aluminum and, 219, 243, 245 balance studies, 17, 40-41, 193, 204-205, 208-209, 211-212, 214-215, 218, 219-221, 223-227, 228, 229, 231, 234, 240-241, 245, 248 bioavailability, 193, 205, 210, 238 and blood pressure, 199-200 bone mineral content, 38, 200 and bone mineral density, 200, 201 calcium and, 135, 137, 142, 191, 194, 197, 200, 201, 213, 214-215, 225, 229, 239 cardiovascular effects, 14, 191, 197-200, 203, 204, 207, 222, 243, 247 children, 14, 30, 41, 196, 205-206, 210-213, 216, 246, 247-248, 316 country reference values compared, 30 critical endpoints, 244-245 data selection, 244 deficiency/depletion, 191, 193, 195, 197-203, 204, 206, 234, 235, 239-240 and diabetes mellitus, 14, 191, 200, 201-202, 203, 204, 207, 239-240 and diarrhea, 242, 243, 244-245, 318 dietary fiber and, 192, 193, 199, 219, 221, 223, 224, 226, 229 and 1,25-dihydroxyvitamin D, 192, 197 distribution and function, 190-191 dose-response relationship, 68, 244-247 EARs, 9, 17, 211, 212, 216-242 energy requirements and, 190, 205, 212, 316 epidemiological studies and meta- analysis, 198, 207-208 estimating requirements for, 202-208 estrogen and, 201 excretion, 193, 194, 202, 204, 206-207, 213, 233, 241, 242 exposure assessment, 247-248 factors affecting requirement, 193-195 food and water sources, 45, 193, 196, 198, 199-200, 207 gender differences, 17, 30, 193, 195-196, 199, 214-215, 216-232, 392-393 hazard identification, 242-244 in human milk, 17, 208, 240 and 25-hydroxyvitamin D, 192, 197 and hypertension, 14, 199-200, 207, 234, 235-237, 244, 249 indicators of nutrient adequacy, 9, 17, 202-209, 210-212, 219-221, 223-226, 228, 231-232, 234-238 in infant formulas, 209-210 infants, 206, 208-210, 234, 235, 236, 243, 246, 247 intakes, 43, 44, 45-46, 48, 193, 195-196, 207, 216, 217-218, 219, 220, 222, 223, 227, 229, 230-231, 233, 234, 235, 238, 239, 241-242, 248, 392-393 interactions with other nutrients, 191, 192, 193, 194-195, 197, 200, 214-215, 224, 239 international comparisons, 209, 234-235 intracellular, 17, 203-204, 232, 234 lactation and, 17, 20, 240-242, 247 and lean body mass, 17, 211, 217, 238, 316 by life-stage group, 17, 20, 208-242, 392-393

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride and malabsorption syndromes, 191, 203 and medicines, 193, 198, 205, 232, 242-244, 245, 247, 249, 318 menopausal status and, 200, 201, 245 metabolism, 192-193, 197, 202 and neuromuscular disorders, 191, 197 NOAEL/LOAELs, 244-245 older adults (+70), 195, 200, 201-202, 203, 204, 207, 231-234, 245 and osteoporosis, 200-201, 207-208, 249 oxalates and, 192, 223 and parathyroid hormone, 193 phosphorus and, 194 physical activity and, 195 and phytates/phytic acid, 194, 221 and potassium, 191, 198, 200 pregnancy, 234-240, 244, 247 protein and, 194-195, 212, 213, 215, 217, 218, 221, 223, 224, 226, 229 race/ethnicity and, 195-196, 200 RDAs, 9, 17, 211, 216, 218, 219, 223, 228, 231, 233-234, 239, 241, 316 and renal function/failure, 191, 193, 201-202, 207, 227, 230, 243, 247 research recommendations, 14, 248-249 risk characterization, 248 serum, 200, 202-203, 204, 234 and skeletal growth, 200-201 sodium and, 190-191, 192, 194 special populations, 195, 239-240, 242, 247 supplements, 45-46, 195, 196, 199, 201, 205, 206-207, 219, 235-237, 238, 243, 244, 246, 247-248 toddlers, 210-212, 213, 216, 246 tolerance tests, 203, 206-207, 231-233, 234-235 ULs, 13, 20, 68, 242-248, 317, 318-319 uncertainty assessment, 68, 233, 245 and vitamin D, 192, 197 weights and heights and, 316 and zinc, 214 Malabsorption disorders, 191, 203, 255 Malnutrition, 84, 120, 311 Medications, interaction with nutrients, 148, 193, 198, 232, 242-244, 245, 247, 248, 275, 278 Men. See also Gender differences balance studies, 111-112, 219-221, 223-226, 228 calcium, 111-112, 135 indicators used to set EARs, 219-221, 223-226, 228 magnesium, 13, 41, 219-227, 228-232, vitamin D, 272 Menarche. See Puberty/pubertal development Menopausal status and bone mass, 76, 86 and bone mineral density, 113-114 caffeine impacts, 76 calcium and, 72, 75, 76, 77-80, 83, 86, 109-110, 112-114 and fluoride, 300 and magnesium, 200, 201, 245 and osteoporosis, 83, 84 sodium impacts, 75 vegetarian diets, 80-81 and vitamin D, 269, 272 Metabolism of nutrients calcium, 259, 261 fluoride, 289-290 magnesium, 192-193, 197, 202 phosphorus, 147-148 vitamin D, 250-255 Methodological considerations. See also Data and data-base issues; Indicators of nutrient adequacy in balance studies, 40-41, 42, 50, 88, 211 concordance between observational and experimental data, 50, 91 data sources, 39-40 epidemiological evidence, 198 extrapolation from absorbed intake to ingested intake, 173 extrapolation from animal studies, 54, 57, 62-63, 66-67, 69, 383, 384 extrapolation from one gender group to another, 90-91, 104, 109 extrapolation from other age groups, 69, 171, 172, 212, 213, 216, 267-268 factorial approach, 40, 110-111 in intracellular magnesium studies, 232 longitudinal data, 50, 86, 91 in nutrient intake estimates, 42-43, 86 in risk assessment, 54, 383-386 in tolerance tests, 207, 233 Mexican Americans, 82, 260 Milk. See Dairy products; Formulas, infant; Human milk Milk-alkali syndrome, 134, 136-137, 138, 139, 140-141 Myocardial infarction, 198-199, 281

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride N National Caries Program, 297-298 National Health and Nutrition Examination Survey I, 202 National Health and Nutrition Examination Survey II, 43, 162, 256 National Health and Nutrition Examination Survey III, 35, 36, 43, 81, 154, 195 National Health Interview Survey, 45, 82, 295 National Heart, Lung, and Blood Institute, 1, 379 National Institute of Dental Research, 297-298 National Research Council, 53, 319, 385 Nephrocalcinosis, 136, 280, 281 Nephrolithiasis (kidney stones), 68, 134-136, 138, 140, 145, 280 Neuromuscular disorders, 191, 197 No-Observed-Adverse-Effect Level (NOAEL) calcium, 137-138, 140 defined, 57 fluoride, 308-309, 310 identification of, 66 intake data and, 47 magnesium, 244-245 phosphorus, 186-187 and UL derivation, 68 uncertainty factor, 67-68 vitamin D, 281-282, 283-284 Nursing homes, 273, 322-323 Nutrient intakes. See also Dietary intakes; specific nutrients calculation of, 43 gender differences, 43-45 inadequate, prevalence of, 319, 320 increasing, strategies for, 10-12, 28, 323 by life stage group, 43, 44 methodological considerations, 42-43, 86 quality of data, 42-43 from supplements, 45-46 Nutrient-nutrient interactions. See Calcium interactions; specific entries under other nutrients and bioavailability, 61 in bone metabolism, 38-39 enhancement with unfortified foods, 11-12, 28 research recommendations, 145 Nutrition Canada Survey, 36 Nutrition During Lactation, 32, 33 Nutritional status, and bioavailability of nutrients, 61 O Older adults. See Adults, 70+ years Osteomalacia, 8, 50, 157, 258, 269, 274 Osteopenia, 83, 275 Osteoporosis, 379 boron status and, 39 calcium and, 9, 47-48, 76, 82, 83, 113, 115, 138, 144 defined, 83 fluoride and, 288, 300, 307 phosphorus and, 186 magnesium and, 200-201, 207-208, 248 menopausal status and, 83 protein and, 76 vitamin D and, 14, 274, 280 Osteosclerosis, 307, 308, 310 Oxalic acid/oxalates, 73, 80, 135, 138, 192, 223 P Parathyroid hormone (PTH) calcium and, 72, 73, 75, 82-83, 117, 120, 132 magnesium and, 193 phosphorus and, 148, 151, 160-161, 178 vitamin D and, 252, 253, 254, 258, 259-260, 262, 264, 266, 269, 272, 274, 287 Phosphorus. See also Hyperphosphatemia; Hypophosphatemia absorption, 147-148, 151, 154, 165, 168, 171, 172, 173, 175, 176-177, 181 accretion, 153, 161, 164-166, 169-171, 172 adolescents, 154, 159, 165, 169-173, 177-178, 179, 180, 184-185, 186, 187-189, 321 adults, 148-149, 153, 154, 156, 173-176, 177-180, 186-187, 188-189 AIs, 16, 160, 162-163 balance studies, 9, 40, 154, 158, 161, 164, 166-167, 168, 169, 171, 176-177 bioavailability, 151-152, 153 bone mineral content, 38, 68, 146, 151, 153, 161, 163, 164, 170, 189

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride and calcium, 61, 135, 147, 148, 151, 152-154, 156, 158, 160-161, 174, 176, 178, 180, 181-184, 185-186 children, 30, 31, 149, 156, 158-159, 164, 166-169, 186, 187 and copper, 180-181, 189 country reference values compared, 30, 31 criteria for deriving, 16, 40 critical endpoint, 186-187 data on, 68, 167, 169, 175 deficiency/depletion, 156-157 and 1,25-dihydroxyvitamin D, 147-148, 151, 176, 181 dose-response assessment, 68, 186-188 EARs, 9, 16, 166, 168, 170, 172, 174-176, 177-179 estimating requirements for, 158-159 excretion, 32, 148, 149, 165, 166, 168, 170-171, 179 exposure assessment, 188-189 extrapolation of DRIs to other ages, 16 factorial approach, 16, 40, 164-166, 168, 170, 172 factors affecting requirement, 151-154 food and water sources, 45, 151-152, 155-156, 161, 173-174, 180, 181, 183-184, 189 gender differences, 30, 31, 154, 155, 156, 168, 172-173, 174-176, 321, 390-391 hazard identification, 180-186 in human milk, 12, 16, 148, 149, 152, 153, 155, 160-163, 178, 183 and immune system, 152, 157 indicators of nutrient adequacy, 9, 158-159, 160-162, 164-168, 169-172, 173-174, 176-177, 178 infants, 32, 146, 148-149, 152, 153, 155, 157, 158-159, 160-163, 176-177, 183, 186-187 intakes, 43, 44, 45-46, 154-156, 166, 168, 172, 174-176, 177-178, 180, 184, 188-189, 321-323, 390-391 interactions with other nutrients, 68, 148, 152-154, 157, 180-181, 189, 194 and iron, 180-181, 189 lactation and, 12, 16, 178-180, 188 by life-stage group, 16, 20, 160-180, 390-391 magnesium and, 194 and medicines, 148 metabolism, 147-148 and metastatic calcification, 180, 183, 184-185, 187 NOAEL/LOAEL, 186-187 older adults (70+), 154, 175-176, 188 and parathyroid hormone, 148, 151, 160-161, 178 physiological distribution and role, 146-147 and phytic acid/phytate, 152, 161, 173 pregnancy and, 12, 16, 176-178, 188 race/ethnicity and, 149, 183-184 RDAs, 9, 16, 166, 169, 172-173, 175, 176, 177-179, 316 renal disease and, 151, 184-185, 186, 188 research recommendations, 189 risk characterization, 189 and serum inorganic phosphate, 16, 148-151, 157, 158-159, 160-161, 162, 163, 171-172, 173-174, 178, 180, 181 and skeletal porosity, 180, 181-182, 185 special considerations, 163, 178, 180, 188 supplements, 45, 156, 189 toddlers, 164-166, 187 ULs, 13, 20, 68, 180-189, 318, 321-322 uncertainty factor, 68, 155 vitamin D and, 38, 184-185, 186 and zinc, 137, 171, 180-181, 189 Physical activity amenorrheic women, 76 and bone mass, 88 calcium and, 74-75, 76, 144 and energy intakes, 28 magnesium and, 195 research recommendations, 144 and skeletal health, 74-75 Phytic acid and phytate, 73, 80, 152, 161, 173, 194, 221 Population Reference Intake, 29 Potassium, 191, 198, 200 Pregnancy. See also Lactation adolescents, 122, 177, 178, 239, 240, 276 balance studies, 120, 176-177 and bone fracture, 121 and bone mineral density, 120-121, 122 and bone mineral mass, 15, 120-121 and calcium, 12, 15, 20, 72, 89-90, 117, 120-122, 142, 176 derivation of DRIs for, 15, 35

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride and 1,25-dihydroxyvitamin D, 176 EARs, 177-178, 238-239 fluoride, 19, 20, 303-305 and gestational diabetes, 235, 239-240 hypertension, 85, 234, 235-238, 244 indicators used to set AIs, 120-121, 275-276 indicators used to set EARs, 176-177, 234-238 intakes of nutrients, 177-178 kinetic studies, 120 and magnesium, 17, 20, 234-240, 244, 247 multiple fetuses, 178, 240 number and spacing, 121, 127-128 outcome studies, 234-238 and phosphorus, 12, 16, 20, 176-178, 188 preeclampsia, 89-90, 235-238 preterm labor and delivery, 234, 235-238, 244 and serum 25(OH)D, 275-276 supplements during, 89-90, 235-237, 238 ULs, 13, 20, 142, 188, 247, 285, 311 vitamin D, 12, 18, 20, 120, 263, 275-276, 285 Processed and refined foods, 196. See also Food additives Prostate cancer, 13, 144, 258 Protein, dietary calcium interaction, 61, 75-76, 135, 144 magnesium and, 194-195, 212, 215, 217, 218, 221, 223, 224, 226, 229 Puberty/pubertal development. See also Adolescents age at onset, 34 calcium and, 14, 49, 72, 99-100, 102, 141 magnesium and 217 racial/ethnic differences, 34, 36-37 vitamin D and, 14, 268, 269, 286 R Race/ethnicity and bioavailability of nutrients, 47-48 and bone fracture, 73, 84-85 and calcium, 73, 82, 89, 144 and dietary intakes, 47-48 and magnesium, 195-196, 200 osteoporosis, 83, 144 and phosphorus, 149, 183-184 research recommendations, 14, 144 and vitamin D, 14, 260, 263, 269-270 Recommended Daily Nutrient Intake, 29 Recommended Dietary Allowance (RDA) for adolescents, 172-173, 177-179, 218, 239, 241 for adults, 175, 176, 177-179, 223, 231, 233-234, 239, 241 AIs compared, 5-8, 26 applicable population, 22 for children, 169, 216, 316 coefficient of variation, 23-25, 216, 218 country comparisons, 29 criteria used to derive, 12, 16 defined, 3, 6, 23, 24, 315 derivation, 3-4, 23-25, 26 EAR and, 3, 3-4, 23-25, 26 increasing consumption of nutrients, 10-12, 28 gender differences, 17 for lactation, 16, 17, 178-179, 241 magnesium, 17, 211, 216, 218, 219, 223, 228, 231, 233-234, 239, 241, 316 phosphorus, 16, 166, 169, 172-173, 175, 176, 177-179, 316 for pregnancy, 16, 17, 177-178, 239 replacement with DRIs, 314 for toddlers, 166, 216 uses, 2, 4, 5, 10, 11, 315-317, 323 Recommended Nutrient Intakes (RNI), 29, 32, 376, 377 Reference Nutrient Intake (RNI), 29 Reference weights and heights, 35-37, 212, 216, 302-303, 309, 316 Renal disease/failure/insufficiency, 60, 280 calcium and, 13, 99, 134-137, 142 magnesium and, 191, 193, 201-202, 207, 227, 230, 243, 247 phosphorus and, 151, 184-185, 186, 188 vitamin D, 280 Requirement, defined, 21 Research recommendations balance studies, 144-145 bone mineral accretion, 14, 189 calcium, 13, 144-145 children, 14 dietary intakes, 14 disease outcomes, 13-14 epidemiological, 13 fluoride, 14, 313 food additives, 189 geographical and racial variables, 14 interactions between nutrients, 145, 189

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride magnesium, 14, 248 methodologies related to disease outcomes, 14 phosphorus, 189 sunscreens, 14 vitamin D, 14, 286-287 Rickets, 8, 50, 157, 254, 257-258, 259, 260, 263, 264-265, 277 Risk, defined, 69 Risk assessment, defined, 53, 69 Risk assessment models. See also UL modeling application to nutrients, 13, 58-62 basic concepts, 53-54 bioavailability considerations, 59, 60-62, 66 and food safety, 53-58 nutrient interactions, 61 process, 54-56 sensitivity of individuals, 59-60 thresholds, 56-58 uncertainties, 54, 57, 58 Risk characterization calcium, 143 defined, 53, 69 fluoride, 312-313 intake data and, 143 magnesium, 247-248 phosphorus, 189 process, 55-56, 57-58 vitamin D, 286 Risk management, 53-54, 56, 70 S Seizures, 197, 275 Selenium, 58 Sensitive subpopulations. See Special considerations Serum calcitrol, 183 1,25-dihydroxyvitamin D, 260 inorganic phosphate, 16, 148-151, 157, 158-159, 160-161, 162, 163, 171-172, 173-174, 178, 180, 181 magnesium, 200, 202-203, 204, 234 25(OH)D, 259-260, 263-264, 265-267, 268, 269-270, 271, 273-274, 275-277 vitamin D, 260 Skeletal health. See also Bone; Osteoporosis fluorosis, 307-308, 310-311, 312 magnesium and, 200-201 phosphorus and, 180, 181-182, 185 porosity, 180, 181-182, 185, 258 vitamin D and, 257-258, 260-261, 262-264 Skin melanin production, 256, 260, 261, 267 Smoking, 88 Sodium, 48, 61, 75, 138, 144, 190-191, 192, 194 Sodium chloride, 75, 192 Soft drinks, 156, 173-174, 180, 183-184, 291, 293-294 Special considerations adolescent pregnancies, 114, 178, 240 breastfeeding twins, 132-133 calcium, 142-143 closely spaced pregnancies, 127-128 diabetes mellitus, 239-240 elderly people, 255 formula-fed infants, 163, 209-210, 265 fluoride, 305-306, 311 granulomatous diseases, 285 identification of, 64-65 lactating adolescents, 180 magnesium, 195, 210, 239-240, 247 medications, 275 multiple infants/births, 178, 180, 240, 242 phosphorus-related, 163, 178, 180, 188 populations with high energy expenditures, 188 renal impairment, 247 vitamin D and, 255, 265, 275, 285 Sprue, 255 Steroid hormone metabolism, 39 Submariners, 270, 271 Sunlight/sun exposure, and vitamin D, 45, 50, 250, 252, 253-254, 255-256, 260, 262-276, 284, 285, 286 Sunscreen, 256, 261, 271, 286 Supplements, dietary bioavailability of nutrients, 22, 62, 74 calcium, 45-46, 74, 77-80, 82, 86, 89, 97-98, 102, 110, 112, 114, 116, 120-121, 123, 126, 130-131, 134, 135, 137, 138, 143, 213, 318, 324 children, 46, 82 data sources on intakes, 45-46 doses, 196, 302 fluoride, 295, 298-299, 302, 304, 311-312

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride gender differences in use, 46, 82, 142 lactation and, 123, 126 magnesium, 45-46, 195, 196, 199, 201, 205, 206-207, 219, 235-237, 238, 243, 244, 246, 247-248 menopausal status and, 77-80, 86 phosphorus, 45-46, 156, 189 pregnancy and, 235-237 ULs and, 4-5, 26, 46, 59 usefulness of, 11, 12, 28 vitamin D, 45-46, 255, 257, 262, 264, 267, 268, 271-272, 274-277, 281-283, 286, 318 Surgeon General's Report on Nutrition and Health, 40 T Tea, fluoride in, 293-294, 300 Tetany, 197, 247 Thyrotoxicosis, 278 Toddlers, ages 1 through 3 years, 33, 46. See also Children AIs, 267-268 bone formation, 284-285 calcium, 96-98 fluoride, 293, 302-303, 309 indicators used to set AIs, 266-267 indicators used to set EARs, 164-166, 210-212 magnesium, 210-212, 213, 216, 246 phosphorus, 164-166, 187 ULs, 141-142, 187, 246, 284-285, 308-309 vitamin D, 266-268, 284-285 Tolerable, defined, 26, 52 Tolerable Upper Intake Levels (ULs), 1, 17, 32. See also UL modeling calcium, 13, 20, 68, 134-143, 318 defined, 4, 6, 24, 26, 51-52, 55, 70, 186, 315 derivation of, 68-69, 246, 282-283, 284, 310-311 fluoride, 68, 306-313, 318 magnesium, 13, 20, 68, 242-248, 317, 318-319 phosphorus, 13, 20, 68, 180-189, 318 selection of, 68 supplement use and, 4-5, 26, 46 uses, 4-5, 11, 26, 317-319 vitamin D, 13, 20, 68, 277-286, 318 Tolerance tests, magnesium, 203, 206-207, 231-233, 234-235 Toothpastes, 291, 295-296, 300 Total Diet Study, 154, 196 Toxicity, mechanisms of action, 64 Trace elements in Human Nutrition and Health, 22, 25 n.2, 52, 319 Twins/multiple births, 178 U UL modeling. See also Dose-response assessment; Risk assessment models calcium, 134-143 critical endpoint, 66, 137-138, 140, 244-245, 310 data selection, 65-66, 137-138, 244 dose-response assessment, 55, 57, 65-69, 137-143, 244-247, 281-285, 308-311 exposure assessment, 55, 57-58, 143, 188-189, 247-248, 285-286, 311-312 fluoride, 306-312 hazard identification, 55, 57, 62-64, 69, 134-137, 180-186, 242-244, 277-281, 306-308 magnesium, 242-248 NOAEL or LOAEL, 47, 66, 69, 137-138, 140, 244-245, 308-309 phosphorus, 180-189 selection of UL, 68, 137-138 uncertainty assessment, 66, 140, 245, 317 vitamin D, 278-286 Uncertainties in AIs, 317 approaches for dealing with, 383-386 assessment, 66, 140, 245, 317 for calcium, 68, 91, 109, 110-111 in data, 54, 58 dose-response assessment, 66-68, 140, 187, 245, 282, 284 for fluoride, 68 inferences from experimental animal studies, 54, 57, 62-63, 66-67 for magnesium, 68, 233, 245 options for dealing with, 383-386 for phosphorus, 68, 155 in risk assessment, 54, 57, 58, 66, 383-386 for vitamin D, 68, 281, 282, 284 Uncertainty Factor (UF), 57, 58, 66-68, 70, 140, 282, 309, 310

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride U.S. Army Medical Research and Materiel Command, 1 U.S. Department of Agriculture, 1, 42, 43, 81, 379 U.S. Department of Health and Human Services, 2, 43 U.S. Environmental Protection Agency, 385 U.S. Food and Drug Administration, 1, 154, 196, 304, 379 V Vegetarian diets, 80-81, 267, 270 Vitamin A, 139 Vitamin C, 38 Vitamin D. See also 1,25-Dihydroxyvitamin D; 25-Hydroxyvitamin D absorption, 253-255 adolescents, 262, 268-269, 276, 277, 284-285, 286 adults, 257, 259, 262, 269-272, 276, 277 AIs, 8, 14, 18, 27, 50, 261-263, 264-265, 266, 267-268, 269, 271, 272, 274, 276, 277 blood and urinary parameters, 279 and bone fracture, 8, 27, 50, 116, 260, 273, 274 and bone mass, 259, 263-264, 271-272, 278 and bone metabolism, 254, 257-258, 284-285 and bone mineral content, 260, 266 and bone mineral density, 14, 260, 261, 264, 271-272, 274 calcium and, 14, 27, 38, 39, 116, 250-253, 254, 255, 258-263, 264, 265, 273, 274, 275, 278, 281-282, 285, 286, 287 and cancer, 258 cardiovascular effects, 281 children, 16, 40-41, 257-258, 259, 260, 262-263, 266-268, 284-285 critical endpoints, 68, 281-282, 283-284 data sources, 43-46, 281, 283 deficiency, 8, 27, 50, 253, 254, 257-258, 259, 263-264, 267, 271 dose-response assessment, 68, 281-285 estimating requirements for, 259-263 excretion, 253-255 exposure assessment, 285-286 factors affecting requirements, 255 food sources, 256-257, 261-262, 268, 269, 270, 271, 283, 284, 285-286 function, 250-253 gender differences, 43-45, 256, 257, 269, 271, 272, 274 geographic location and, 14, 259, 264-267, 269-270, 271, 273, 274, 281, 284, 286 and granulomatous diseases, 255, 285 hazard identification, 277-281 in human milk, 263, 262, 264, 265-266, 276-277 and hypercalcemia, 278, 280, 281-283, 284, 285 and hyperparathyroidism, 258, 270, 273, 274, 278, 280 indicators of nutrient adequacy, 18, 27, 50, 259-261, 263-264, 265-267, 268, 269-270, 271-272, 273-274, 275-277 infants, 68, 259, 260, 262-266, 269-270, 275, 277, 283-284 intakes, 14, 27, 43-46, 50, 253, 255, 256, 257, 261-262, 267-268, 275, 285-286, 318 interaction with other nutrients, 192, 193, 197 intoxication, 184-185, 186, 256, 277-287 lactation and, 12, 18, 276-277, 285 life-stage group and, 18, 43-45, 263-277 and linear growth, 263-264, 283 magnesium and, 192, 197 malabsorption disorders, 255 medications and, 275, 278 menopausal status and, 269, 272 and metabolic bone disease, 259 metabolism, 250-255 NOAEL/LOAELs, 281-282, 283-284 older adults, 116, 255, 273-274, 287 and osteomalacia, 8, 50, 258, 269, 274 and osteopenia, 275 and osteoporosis, 14, 27, 274, 280 and parathyroid hormone, 252, 253, 254, 258, 259-260, 262, 264, 266, 269, 272, 274, 287 phosphorus and, 38, 184-185, 186, 250, 253, 254, 258, 260, 265 pregnancy and, 12, 18, 117, 263, 275-276, 285 puberty and, 268, 269, 286 race/ethnicity and, 260, 263, 269-270 receptor polymorphisms, 14

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DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride and renal disease, 280 research recommendations, 14, 286-287 and rickets, 8, 50, 254, 257-258, 259, 260, 263, 264-265, 277 risk characterization, 286 safety factor, 8, 50 serum, 260 and skeletal health, 257-258, 260-261, 262-264 special considerations, 255, 265, 275, 285 submariners, 270, 271 sun exposure and, 45, 50, 250, 252, 253-254, 255-256, 260, 262-276, 284, 285, 286 sunscreen and, 14, 256, 261, 271, 286 supplements, 45-46, 255, 257, 262, 264, 267, 268, 271-272, 274-277, 281-283, 286, 318 toddlers, 266-268, 284-285 ULs, 13, 20, 68, 277-286, 318 uncertainty and uncertainty factors, 68, 281, 282, 284 vegetarians, 267, 270 Vitamin E, 139 Vitamin K, 38-39, 60 W Water. See Drinking water Weight. See Reference weights and heights Weight-bearing practices, 42, 68 Women. See also Gender differences; Lactation; Menopausal status; Pregnancy amenorrheic, 76 balance studies, 220, 221, 225, 226 calcium, 72, 75, 109-110, 111-114, 135, 143 fluoride, 301-306 indicators used to set AIs, 111-114 indicators used to set EARs, 221, 226 intakes of nutrients, 43-45 magnesium, 30, 220, 222-223, 225, 227, 230-231, 233 phosphorus, 30, 31, 155, 316, 321, 322-323 vitamin D, 43-45, 256, 272, 273 World Health Organization, 22, 52, 83, 319, 322 Y Young adults. See Adults, 19 through 30 years Z Zinc, 38, 59, 137, 140, 141, 142, 171, 180-181, 189, 214 Zinc oxide, 53

Representative terms from entire chapter:

balance studies