Health Canada Update: Dietary Reference Intakes for Calcium and Vitamin D Hélène Lowell, RD Office of Nutrition Policy and Promotion OSNPPH – June 3 rd,

Health Canada Update:Dietary Reference Intakes for

Calcium and Vitamin D

Hélène Lowell, RDOffice of Nutrition Policy and Promotion

OSNPPH – June 3rd, 2011

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Purpose

• Review highlights contained within the report

• Share preliminary implementation plans

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Scope of IOM Committee’s Work

• Report commissioned by US and Canadian governments– Review evidence regarding health outcomes relevant to

developing DRIs for vitamin D and calcium – Update DRIs for vitamin D and calcium, as appropriate– Incorporate risk assessment approach– Enhance transparency and “risk characterization”

discussions– Identify research needs

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Indicators of health outcomes

• Asked committee to use risk assessment framework– DRI indicators selected based on strength and quality of

evidence

• Asked to consider indicators of chronic diseases– Many potential indicators reviewed– Indicator of adequacy chosen for both vitamin D and

calcium: bone health – Other indicators not currently supported by evidence –

inconsistent, no cause-and-effect relationship.

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Vitamin D

• Asked committee to consider issues such as latitude, sun exposure, and skin pigmentation

• DRIs for vitamin D set on the basis of minimal sun exposure– Vitamin D requirements could not address the

level of sun exposure because of public health concerns about skin cancer

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Vitamin D

• Benefit for most people is associated with serum 25(OH)D levels of ~50 nmol/L– EARs and RDAs set on basis of achieving levels of

40 nmol/L and 50 nmol/L, respectively– RDA higher for adults >70 because of greater

variability around mean requirement

• UL is based on hypercalcemia and related toxicity– Margin of safety applied

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Vitamin DAge group Estimated Average

Requirement (EAR) per day

Recommended Dietary Allowance (RDA) per day

Tolerable Upper Intake Level (UL) per day

Infants 0-6 months - 400 IU (10 mcg) * 1000 IU (25 mcg)

Infants 7-12 months - 400 IU (10 mcg) * 1500 IU (38 mcg)

Children 1-3 years 400 IU (10 mcg) 600 IU (15 mcg) 2500 IU (63 mcg)

Children 4-8 years 400 IU (10 mcg) 600 IU (15 mcg) 3000 IU (75 mcg)

Children and Adults 9-70 years

400 IU (10 mcg) 600 IU (15 mcg) 4000 IU (100 mcg)

Adults > 70 years 400 IU (10 mcg) 800 IU (20 mcg) 4000 IU (100 mcg)

Pregnancy & Lactation 400 IU (10 mcg) 600 IU (15 mcg) 4000 IU (100 mcg)

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Calcium

• EARs and RDAs set on basis of calcium balance studies (accumulation and level of bone mass)

• UL is based on kidney stone formation– Margin of safety applied

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CalciumAge group Estimated Average

Requirement (EAR) per day

Recommended Dietary Allowance (RDA) per day

Tolerable Upper Intake Level (UL) per day

Infants 0-6 months - 200 mg * 1000 mg

Infants 7-12 months - 260 mg * 1500 mg

Children 1-3 years 500 mg 700 mg 2500 mg

Children 4-8 years 800 mg 1000 mg 2500 mg

Children 9-18 years 1100 mg 1300 mg 3000 mg

Adults 19-50 years 800 mg 1000 mg 2500 mg

Adults 51-70 years

Men

Women

800 mg

1000 mg

1000 mg

1200 mg

2000 mg

2000 mg

Adults > 70 years 1000 mg 1200 mg 2000 mg

Pregnancy & Lactation

14-18 years

19-50 years

1100 mg

800 mg

1300 mg

1000 mg

3000 mg

2500 mg

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Implementation of revised DRIs• Internal DRI working group – ensure that there is coordination of analysis of report, the

Canadian DRI Steering Committee, and the use of the Expert Advisory Committee

– identified policies that could be affected

• Expert Advisory Committee set up through the Canadian Academy of Health Sciences– Not re-questioning science implementation advice– Quick turnaround on specific questions

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Implementation of revised DRIs• Canadian Academy of Health Sciences (CAHS)

– Mission is provide assessments of and advice on key issues relevant to the health of Canadians

• Expert Advisory Committee (EAC)– Independent of Health Canada (new model)– Membership posted on CAHS website

• Method Questions sent to EAC– HC considers EAC response– Actions could include: proposed policy changes, consultation,

follow-up questions for EAC

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CCHS Calcium IntakesAge group Usual intakes from

food below EARUsual intakes from food above UL

Percentage (SE)

CHILDREN 1-3 years 3.2% (0.7)E <3

4-8 years 23.3% (2.1) <3

MALE 9-13 years 43.9% (2.9) <3

14-18 years 33.4% (3.0) <3

19-30 years 26.5% (3.2) <3

31-50 years 39.0% (2.8) <3

51-70 years 53.0% (2.5) <3

> 70 years 80.1% (3.0) <3

FEMALE 9-13 years 66.9% (3.0) <3

14-18 years 70.0% (2.5) <3

19-30 years 47.5% (3.6) <3

31-50 years 51.9% (3.0) <3

51-70 years 82.4% (1.5) <3

> 70 years 86.9% (1.8) <3E: Data with a coefficient of variation (CV) from 16.6% to 33.3%; interpret with caution.

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Calcium: implementation

• Large prevalence of inadequate intakes

• Narrow margin between RDA and UL

• Question to EAC on potential approaches to increase calcium intakes

– Benefits/drawbacks– Vulnerable subgroups

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CCHS Vitamin D IntakesAge group Usual intakes from food

below EARUsual intakes from food above UL

Percentage (SE)

CHILDREN 1-3 years 86.0% (1.5) 0

4-8 years 92.7% (1.2) 0

MALE 9-13 years 84.5% (2.0) 0

14-18 years 74.7% (2.3) 0

19-30 years 91.1% (2.4) 0

31-50 years 90.5% (2.1) 0

51-70 years 79.6% (3.6) 0

> 70 years 87.1% (2.6) 0

FEMALE 9-13 years 93.1% (1.4) 0

14-18 years 93.5% (1.4) 0

19-30 years 96.4% (1.1) 0

31-50 years 91.1% (2.9) 0

51-70 years 90.7% (2.5) 0

> 70 years 91.8% (1.9) 0

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Vitamin D status of Canadians (CHMS)

• 4% of Canadians vitamin D deficient (<27.5 nmol/L)

• 10% of Canadians have levels inadequate for bone health (<37.5 nmol/L)

• Low milk consumption and non-white racial background associated with lower vit. D concentrations

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Vitamin D status – lack of consensus on cut- off values

• Raised as important issue by IOM

• DRI committee suggests:• <30 nmol/L risk of deficiency

• 30-50 nmol/L potential risk of inadequacy

• >50 nmol/L practically all are sufficient

• >75 nmol/L no increased benefit

• >125 nmol/L may be reason for concern

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Vitamin D: implementation

• Need to consider vitamin D blood values along with dietary intakes (food only and combined with vit/min supps) before any changes to public health policies and programs are made

• Question to EAC on whether there is a need to increase vitamin D intakes

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Next Steps

• EAC responses by September, 2011

• Timelines for implementation will vary depending on the particular policy being considered