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

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

1 Health Canada Update: Dietary Reference Intakes for Calcium and Vitamin D Hélène Lowell, RD Office of Nutrition Policy and Promotion OSNPPH – June 3 rd, 2011

2 2 Purpose Review highlights contained within the report Share preliminary implementation plans

3 3 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

4 4 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.

5 5 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

6 6 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

7 7 Vitamin D Age groupEstimated 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 years400 IU (10 mcg)600 IU (15 mcg)2500 IU (63 mcg) Children 4-8 years400 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 years400 IU (10 mcg)800 IU (20 mcg)4000 IU (100 mcg) Pregnancy & Lactation400 IU (10 mcg)600 IU (15 mcg)4000 IU (100 mcg)

8 8 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

9 9 Calcium Age groupEstimated 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 years500 mg700 mg2500 mg Children 4-8 years800 mg1000 mg2500 mg Children 9-18 years1100 mg1300 mg3000 mg Adults years800 mg1000 mg2500 mg Adults years Men Women 800 mg 1000 mg 1200 mg 2000 mg Adults > 70 years1000 mg1200 mg2000 mg Pregnancy & Lactation years years 1100 mg 800 mg 1300 mg 1000 mg 3000 mg 2500 mg

10 10 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

11 11 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

12 12 CCHS Calcium Intakes Age groupUsual intakes from food below EAR Usual intakes from food above UL Percentage(SE) CHILDREN 1-3 years3.2%(0.7)E<3 4-8 years23.3%(2.1)<3 MALE 9-13 years43.9%(2.9)< years33.4%(3.0)< years26.5%(3.2)< years39.0%(2.8)< years53.0%(2.5)<3 > 70 years80.1%(3.0)<3 FEMALE 9-13 years66.9%(3.0)< years70.0%(2.5)< years47.5%(3.6)< years51.9%(3.0)< years82.4%(1.5)<3 > 70 years86.9%(1.8)<3 E: Data with a coefficient of variation (CV) from 16.6% to 33.3%; interpret with caution.

13 13 Calcium: implementation Large prevalence of inadequate intakes Narrow margin between RDA and UL Question to EAC on p otential approaches to increase calcium intakes – Benefits/drawbacks – Vulnerable subgroups

14 14 CCHS Vitamin D Intakes Age groupUsual intakes from food below EAR Usual intakes from food above UL Percentage(SE) CHILDREN 1-3 years86.0%(1.5)0 4-8 years92.7%(1.2)0 MALE 9-13 years84.5%(2.0) years74.7%(2.3) years91.1%(2.4) years90.5%(2.1) years79.6%(3.6)0 > 70 years87.1%(2.6)0 FEMALE 9-13 years93.1%(1.4) years93.5%(1.4) years96.4%(1.1) years91.1%(2.9) years90.7%(2.5)0 > 70 years91.8%(1.9)0

15 15 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

16 16 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 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

17 17 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

18 18 Next Steps EAC responses by September, 2011 Timelines for implementation will vary depending on the particular policy being considered


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