National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

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

Standing Committee on the Scientific Evaluation of Dietary Reference Intakes

Food and Nutrition Board

Institute of Medicine

NATIONAL ACADEMY PRESS
Washington, D.C.

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

This project was funded by the U.S. Department of Agriculture (Grant No. 59-0700-6-061), the National Institutes of Health (Grant No. N01-OD-4-2139, TO 19), the Food and Drug Administration (Grant No. 223-90-2223), and with assistance from Health Canada. The opinions or conclusions expressed herein do not necessarily reflect those of the funders.

Library of Congress Cataloging-in-Publication Data

Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride / Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine.

p. cm.

Includes bibliographical references and index.

ISBN 0-309-06350-7 (cloth). — ISBN 0-309-06403-1 (pbk.)

1. Diet. 2. Nutrition. I. Institute of Medicine (U.S.).

Standing Committee on the Scientific Evaluation of Dietary Reference Intakes.

TX551.D466 1997

613.2′85—dc21

97-33777

Additional copies of this report are available from the National Academy Press
, 2101 Constitution Avenue, NW, Lock Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington Metropolitan Area). Order electronically via Internet at http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at http://www.nap.edu/iom.

Copyright 1997 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

STANDING COMMITTEE ON THE SCIENTIFIC EVALUATION OF DIETARY REFERENCE INTAKES

VERNON R. YOUNG (Chair), *

Laboratory of Human Nutrition, School of Science, Massachusetts Institute of Technology, Cambridge

JOHN W. ERDMAN, JR. (Vice Chair),

Division of Nutritional Sciences, College of Agricultural, Consumer and Environmental Sciences, University of Illinois, Urbana-Champaign

JANET C. KING (Vice-Chair), *

U.S. Department of Agriculture Western Human Nutrition Research Center, Presidio of San Francisco

LINDSAY H. ALLEN,

Department of Nutrition, University of California, Davis

STEPHANIE A. ATKINSON,

Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Canada

JOHANNA T. DWYER,

Frances Stern Nutrition Center, New England Medical Center and Tufts University, Boston, Massachusetts

JOHN D. FERNSTROM,

University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania

SCOTT M. GRUNDY, *

Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas

CHARLES H. HENNEKENS,

Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts

SANFORD A. MILLER,

Graduate School of Biomedical Sciences, University of Texas Health Science Center, San Antonio

U.S. Government Liaison

LINDA MEYERS,

Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Washington, D.C.

Canadian Government Liaison

PETER W.F. FISCHER,

Nutrition Research Division, Health Protection Branch, Health Canada, Ottawa, Canada

Staff

ALLISON A. YATES, Study Director

CAROL W. SUITOR, Senior Program Officer, Study Director (April 1997–July 1997)

SANDRA A. SCHLICKER, Senior Program Officer

SHEILA A. MOATS, Research Associate (April 1996–November 1996)

*  

Member, Institute of Medicine.

†  

Member, National Academy of Sciences.

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

ELISABETH A. REESE, Research Associate

KIMBERLY A. BREWER, Research Assistant

ALICE L. KULIK, Research Assistant

DONNA M. LIVINGSTON, Project Assistant (April 1996–January 1997)

GERALDINE KENNEDO, Project Assistant

GAIL E. SPEARS, Administrative Assistant

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

PANEL ON CALCIUM AND RELATED NUTRIENTS

STEPHANIE A. ATKINSON (Chair),

Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Canada

STEVEN A. ABRAMS,

Department of Pediatrics, Baylor College of Medicine, USDA Children 's Nutrition Research Center, Houston, Texas

BESS DAWSON-HUGHES,

Calcium and Bone Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts

ROBERT P. HEANEY, John A. Creighton University Professor,

Creighton University, Omaha, Nebraska

MICHAEL F. HOLICK,

Endocrinology, Nutrition and Diabetes Section and Vitamin D, Skin, and Bone Research Laboratory, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts

SUZANNE P. MURPHY,

Department of Nutritional Sciences, University of California, Berkeley

ROBERT K. RUDE,

Department of Medicine, University of Southern California, Los Angeles

BONNY L. SPECKER,

Department of Pediatrics, University of Cincinnati and Children's Hospital Medical Center, Ohio

CONNIE M. WEAVER,

Department of Food and Nutrition, Purdue University, West Lafayette, Indiana

GARY M. WHITFORD,

Department of Oral Biology and Physiology, School of Dentistry, Medical College of Georgia, Augusta

Staff

SANDRA A. SCHLICKER, Study Director

SHEILA A. MOATS, Research Associate (April 1996–November 1996)

ELISABETH A. REESE, Research Associate

KIMBERLY A. BREWER, Research Assistant

ALICE L. KULIK, Research Assistant

DONNA M. LIVINGSTON, Project Assistant (April 1996–January 1997)

GERALDINE KENNEDO, Project Assistant

GAIL E. SPEARS, Administrative Assistant

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

SUBCOMMITTEE ON UPPER REFERENCE LEVELS OF NUTRIENTS

IAN C. MUNRO (Chair),

CanTox, Incorporated, Mississauga, Canada

STEVEN A. ABRAMS,

Baylor College of Medicine, USDA Children's Nutrition Research Center, Houston, Texas

ROBERT P. HEANEY, John A. Creighton University Professor,

Creighton University, Omaha, Nebraska

WALTER MERTZ,

Retired, Human Nutrition Research Center, Rockville, Maryland

RITA B. MESSING,

Minnesota Department of Health, Division of Environmental Health, St. Paul

SANFORD A. MILLER,

Graduate School of Biomedical Sciences, University of Texas Health Sciences Center, San Antonio

SUZANNE P. MURPHY,

Department of Nutritional Sciences, University of California, Berkeley

JOSEPH V. RODRICKS,

ENVIRON Corporation, Arlington, Virginia

IRWIN H. ROSENBERG, *

Clinical Nutrition Division, USDA Human Nutrition Research Center on Aging, Tufts University and New England Medical Center, Boston, Massachusetts

STEVE L. TAYLOR,

Department of Food Science and Technology, University of Nebraska, Lincoln

ROBERT H. WASSERMAN,

Department of Physiology, College of Veterinary Medicine, Cornell University, Ithaca, New York

Consultants

SHEILA DUBOIS, Food Directorate,

Health Canada, Ottawa, Canada

HERBERT BLUMENTHAL,

Retired, Food and Drug Administration, Washington, D.C.

Staff

SANDRA A. SCHLICKER, Study Director

SHEILA A. MOATS, Research Associate (April 1996–November 1996)

ELISABETH A. REESE, Research Associate

KIMBERLY A. BREWER, Research Assistant

ALICE L. KULIK, Research Assistant

DONNA M. LIVINGSTON, Project Assistant (April 1996–January 1997)

GERALDINE KENNEDO, Project Assistant

GAIL E. SPEARS, Administrative Assistant

*  

Member, Institute of Medicine.

†  

Member, National Academy of Sciences.

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

FOOD AND NUTRITION BOARD

CUTBERTO GARZA (Chair),

Division of Nutrition, Cornell University, Ithaca, New York

JOHN W. ERDMAN, JR. (Vice Chair),

Division of Nutritional Sciences, College of Agricultural, Consumer and Environmental Sciences, University of Illinois, Urbana-Champaign

LINDSAY H. ALLEN,

Department of Nutrition, University of California, Davis

BENJAMIN CABALLERO,

Center for Human Nutrition, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland

FERGUS M. CLYDESDALE,

Department of Food Science, University of Massachusetts, Amherst

ROBERT J. COUSINS,

Center for Nutritional Sciences, University of Florida, Gainesville

MICHAEL P. DOYLE,

Center for Food Safety and Quality Enhancement, Department of Food Science and Technology, University of Georgia, Griffin

JOHANNA T. DWYER,

Frances Stern Nutrition Center, New England Medical Center and Tufts University, Boston, Massachusetts

SCOTT M. GRUNDY, *

Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas

CHARLES H. HENNEKENS,

Department of Medicine, Ambulatory Care and Prevention, Harvard Medical School, and Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts

JANET C. KING, *

University of California, Berkeley, and U.S. Department of Agriculture Western Human Nutrition Research Center, Presidio of San Francisco

SANFORD A. MILLER,

Graduate School of Biomedical Sciences, University of Texas Health Science Center, San Antonio

ROSS L. PRENTICE, *

Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington

A. CATHARINE ROSS,

Department of Nutrition, The Pennsylvania State University, University Park

ROBERT E. SMITH,

R.E. Smith Consulting, Incorporated, Newport, Vermont

VIRGINIA A. STALLINGS,

Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania

VERNON R. YOUNG, *

Laboratory of Human Nutrition, School of Science, Massachusetts Institute of Technology, Cambridge

*  

Member, Institute of Medicine.

†  

Member, National Academy of Sciences.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

Ex-Officio Member

STEVE L. TAYLOR,

Department of Food Science and Technology and Food Processing Center, University of Nebraska, Lincoln

Institute of Medicine Council Liaison

HARVEY R. COLTEN, *

Northwestern University School of Medicine, Chicago, Illinois

Staff

ALLISON A. YATES, Director

GAIL E. SPEARS, Administrative Assistant

CARLOS GABRIEL, Financial Associate

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

Preface

This report represents the initial report of a major new activity of the Food and Nutrition Board (FNB): the development of a comprehensive set of reference values for dietary nutrient intakes for the healthy population in the United States and Canada. Hallmarks of the new activity include (1) the establishment of a set of reference values to replace the Recommended Dietary Allowances (RDAs) for the United States published previously by the FNB; (2) for the first time, a single set of reference values for the United States and Canada; (3) the clear documentation of the derivation of the reference values; (4) the promotion of nutrient function and biologic-physical well-being; (5) the consideration of evidence concerning the prevention of disease and developmental disorders in addition to more traditional evidence of sufficient nutrient intake (for example, prevention of deficiency); (6) the examination of data about selected food components that have not been considered essential nutrients; and (7) recommendations for future research directions based on the knowledge gaps identified.

Since the publication of the last version of the U.S. Recommended Dietary Allowances (NRC, 1989a) and of the Canadian Recommended Nutrient Intakes (Health Canada, 1990), there has been a significant expansion of the research base, an increased understanding of nutrient requirements and food constituents, and a better appreciation for the different types of nutrient data needed to address the applications of dietary reference values for individuals and population groups. There are now convincing reasons to conclude that

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

past approaches to establishing and applying the RDAs can be improved.

Thus, the FNB considered it essential to reassess the nutrient requirement estimates that are needed for various purposes, how estimates of nutrient requirements should be developed, and how these values could be used in various settings of clinical and public health importance. To this end, the FNB's Standing Committee on the Scientific Evaluation of Dietary Reference Intakes (DRI Committee) is taking steps that should help eliminate some of the limitations, misinterpretations, and misuses of the 1989 RDAs and their predecessors. Indeed, the DRI Committee has already concluded that the 1989 edition of the Recommended Dietary Allowances should now be replaced in its entirety, rather than merely updated, by a new series of publications.

The DRI Committee aims to achieve a consistent and coherent definition of requirements and of reference intakes for all essential nutrients and food components evaluated. (A brief description of the process is given in Appendix A.) In this context, the reference intake values presented in this and subsequent reports should have a broad, enduring, and useful application.

This report defines requirements and other reference intake values for calcium, phosphorus, magnesium, vitamin D, and fluoride and represents the first in a series of reports providing both dietary reference intakes and guidance related to how to use them. Changes in the prepublication version (which was released in August, 1997) have been made to increase the readability and clarity of the information provided. Improvements in format and descriptions have been made consistent with the second report released in the series (which covers B vitamins and choline, the prepublication version of which was released in April, 1998). The DRI Committee deeply appreciates the comments received from many reviewers and individuals following the release of the prepublication version.

Because of the limitations of present scientific knowledge, there are differences of opinion among scientists about some of the matters covered in this report. Reaching agreement on the interpretation of the evidence relating to calcium requirements has been a challenge, both because of the compelling conceptual argument to use maximal calcium retention as an indicator of adequacy as was presented in the prepublication version of this report, and subsequent statistical questions raised in the methodology used to estimate it after that version was released. In order to address these statistical issues, the DRI Committee chose in this final printed version of the report to refer to the indicator of adequacy used to

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

establish recommended intakes for calcium as desirable calcium retention. The balance data originally used in assessing maximal calcium retention were then recalculated (see Appendix E) to establish the estimates for adequacy of dietary calcium based on achieving the estimated desirable amount of calcium retention. In either case, consistent achievement of either maximal or desirable calcium intakes as the indicator of adequacy is presumed to reduce the risk of fracture secondary to osteopenia or osteoporosis.

After much careful weighing of the evidence, the DRI Committee determined that, because reducing risk of chronic disease was the intended endpoint and there were many uncertainties about the epidemiologic and experimental data, the setting of Estimated Average Requirements and Recommended Dietary Allowances for calcium could not be justified. Thus, as described in the report, Adequate Intake values were set instead.

It is not the function of this report, given the scope of work (see Appendix A, “Charge to the Panel on Calcium and Related Nutrients and Subcommittee on Upper Reference Levels”), to address applications of the DRIs. However, some uses for the different types of DRIs are described briefly in Chapter 9. The DRI Committee intends to issue a subsequent report that will focus on the uses of DRIs in various settings.

It is hoped that the critical, comprehensive analyses of available information and of knowledge gaps will greatly assist the private sector, foundations, universities, government laboratories, and other institutions with their research interests and with the development of an exciting and realistic research agenda for the next decade.

The support of Canada and Canadian scientists in this initiative for DRIs represents a pioneering first step toward the standardization of nutrient reference intakes at least within one continent.

This report reflects the work of the FNB's DRI Committee, an expert Panel on Calcium and Related Nutrients, and the Subcommittee on Upper Reference Levels of Nutrients. The committee, the panel, and the subcommittee owe a considerable debt of gratitude to the many experts who have assisted with this report. Many, but far from all, of these people are named in Appendix B. Thanks also go to the many experts who devoted so much time to discussing these issues and to Burton Altura, Chor San Khoo, and Charles Pak, initial members of the Panel on Calcium and Related Nutrients and/or the Subcommittee on Upper Reference Levels of Nutrients. The respective chairs and members of the panel and subcommittee have performed their work under great time pressure. It

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×

is because of their dedication that this report has come into being. All gave of their time willingly and without financial reward; both the science and practice of nutrition are major beneficiaries.

The DRI Committee wishes to acknowledge the tireless efforts of the former and present FNB chairs, Janet King and Cutberto Garza, who began the initiative and played a key role in securing the funding that has been received to date. Similarly, thanks go to Allison Yates who has been instrumental in guiding this complex activity, and to Stephanie Atkinson and Ian Munro, who gave generously of their time and effort in chairing the Panel on Calcium and Related Nutrients and the Subcommittee on Upper Reference Levels of Nutrients, respectively. Finally, it is the staff of FNB who get the work completed. Special gratitude is expressed to Sandra Schlicker, study director for both the calcium panel and subcommittee, and Carol Suitor, who assumed the added responsibility of acting director of the FNB during the last few months of this project. The committee also recognizes the contributions of Elisabeth Reese, Kimberly Brewer, Alice Kulik, Sheila Moats, Gail Spears, Donna Livingston, and Geraldine Kennedo. We also thank Judith Grumstrup-Scott for editing the manuscript and Mike Edington and Claudia Carl for assistance with publication.

Vernon Young

Chair, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes

Cutberto Garza

Chair, Food and Nutrition Board

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
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Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
×
   

 Application of the Risk Assessment Model to Nutrients,

 

58

   

 Steps in the Development of the UL,

 

62

   

 Glossary,

 

69

 4

 

CALCIUM

 

71

   

 Background Information,

 

71

   

 Estimating Requirements for Calcium,

 

84

   

 Findings by Life Stage and Gender Group,

 

91

   

 Tolerable Upper Intake Levels,

 

134

   

 Research Recommendations

 

144

 5

 

PHOSPHORUS

 

146

   

 Background Information,

 

146

   

 Estimating Requirements for Phosphorus,

 

158

   

 Findings by Life Stage and Gender Group,

 

160

   

 Tolerable Upper Intake Levels,

 

180

   

 Research Recommendations,

 

189

 6

 

MAGNESIUM

 

190

   

 Background Information,

 

190

   

 Estimating Requirements for Magnesium,

 

202

   

 Findings by Life Stage and Gender Group,

 

208

   

 Tolerable Upper Intake Levels,

 

242

   

 Research Recommendations,

 

248

 7

 

VITAMIN D

 

250

   

 Background Information,

 

250

   

 Estimating Requirements for Vitamin D,

 

259

   

 Findings by Life Stage and Gender Group,

 

263

   

 Tolerable Upper Intake Levels,

 

278

   

 Research Recommendations,

 

286

 8

 

FLUORIDE

 

288

   

 Background Information,

 

288

   

 Estimating Requirements for Fluoride,

 

298

   

 Findings by Life Stage and Gender Group,

 

301

   

 Tolerable Upper Intake Levels,

 

306

   

 Research Recommendations,

 

313

 9

 

USES OF DIETARY REFERENCE INTAKES

 

314

   

 Overview,

 

314

   

 Using Recommended Dietary Allowances,

 

315

   

 Using Adequate Intakes,

 

317

Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
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Suggested Citation:"Front Matter." Institute of Medicine. 1997. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: The National Academies Press. doi: 10.17226/5776.
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Since 1941, Recommended Dietary Allowances (RDAs) has been recognized as the most authoritative source of information on nutrient levels for healthy people. Since publication of the 10th edition in 1989, there has been rising awareness of the impact of nutrition on chronic disease. In light of new research findings and a growing public focus on nutrition and health, the expert panel responsible for formulation RDAs reviewed and expanded its approach--the result: Dietary Reference Intakes.

This new series of references greatly extends the scope and application of previous nutrient guidelines. For each nutrient the book presents what is known about how the nutrient functions in the human body, what the best method is to determine its requirements, which factors (caffeine or exercise, for example) may affect how it works, and how the nutrient may be related to chronic disease.

The first volume of Dietary Reference Intakes includes calcium, phosphorus, magnesium, vitamin D, and fluoride. The second book in the series presents information about thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline.

Based on analysis of nutrient metabolism in humans and data on intakes in the U.S. population, the committee recommends intakes for each age group--from the first days of life through childhood, sexual maturity, midlife, and the later years. Recommendations for pregnancy and lactation also are made, and the book identifies when intake of a nutrient may be too much. Representing a new paradigm for the nutrition community, Dietary Reference Intakes encompasses:

  • Estimated Average Requirements (EARs). These are used to set Recommended Dietary Allowances.
  • Recommended Dietary Allowances (RDAs). Intakes that meet the RDA are likely to meet the nutrient requirement of nearly all individuals in a life-stage and gender group.
  • Adequate Intakes (AIs). These are used instead of RDAs when an EAR cannot be calculated. Both the RDA and the AI may be used as goals for individual intake.
  • Tolerable Upper Intake Levels (ULs). Intakes below the UL are unlikely to pose risks of adverse health effects in healthy people.

This new framework encompasses both essential nutrients and other food components thought to pay a role in health, such as dietary fiber. It incorporates functional endpoints and examines the relationship between dose and response in determining adequacy and the hazards of excess intake for each nutrient.

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