For Professional Reference Only
Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
Recommendations
The Dietary Reference Intakes for calcium and vitamin D intake from all sources are:
Age
1-3 years
4-8 years
9-18 years
19-50 years
51-70 years
Over 70 years
Calcium
RDA
700 mg
1000 mg
1300 mg
1000 mg
males: 1000 mg
females: 1200 mg
1200 mg
Vitamin D
UL
2500 mg
2500 mg
3000 mg
2500 mg
RDA
600 IU
600 IU
600 IU
600 IU
UL
2500 IU
3000 IU
4000 IU
4000 IU
2000 mg
600 IU
4000 IU
2000 mg
800 IU
4000 IU
Pregnant and breastfeeding recommendations do not differ from age guidelines.
RDA = Recommended Dietary Allowance (daily intake level that meets the needs of most (97%-98%) individuals in
an age and gender group); UL = Tolerable Upper Intake Level (highest average daily intake level likely to pose no
risk to almost all individuals)
Institute of Medicine, Dietary Reference Intakes for Calcium and Vitamin D, 2010
To help achieve these vitamin D intakes Nutrition Services, Alberta Health Services recommends that
healthy individuals include food sources of vitamin D in their diet, and supplement their intake as
follows:
• 1 to 70 years: take 400 IU vitamin D per day as a supplement.
• Over the age of 70: take 800 to 1000 IU vitamin D per day as a supplement.
For adults at risk of or diagnosed with osteoporosis:
• 19 to 50 years:
o
Vitamin D – include food sources of vitamin D in their diet, and take 400 to 1000 IU per day as a
supplement.
o
Calcium – get 1000 mg per day from food and supplements combined.
• Over 50 years:
o
o
•
•
Vitamin D – include food sources of vitamin D in their diet, and take 800 to 2000 IU per day as a
supplement.
Calcium – get 1200 mg per day from food and supplements combined.
The recommendations above should apply in all areas of Alberta with no differentiation between northern
and southern parts of the province.
Blood tests for serum vitamin D levels should only be done for individuals at high risk of deficiency.
February 2013
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Nutrition Guideline
Calcium and Vitamin D
For Professional Reference Only
Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
Health Benefits
•
•
•
•
Calcium and vitamin D are needed for proper growth and maintenance of healthy bones and teeth.1
Adequate intakes help prevent and treat bone diseases such as rickets, osteopenia and osteoporosis.1
Calcium is also involved in vascular contraction and vasodilation, muscle contraction, nerve
transmission and the secretion of certain hormones and enzymes.2,3
Vitamin D aids in the absorption of calcium and phosphorus to help maintain normal serum levels of
these minerals to ensure normal mineralization of bone and to prevent hypocalcemia.4
Calcium and vitamin D have been studied in relation to cancer (including colon and prostate cancer),
cardiovascular disease, hypertension, diabetes, metabolic syndrome, weight management, falls and
physical performance, immune function, autoimmune disorders, infections, neuropsychological function,
and preeclampsia. Currently there is not enough evidence to clearly establish the effects of calcium or
vitamin D on these health conditions, or to make recommendations about requirements to prevent or
manage these conditions.3,4,5
Key Questions
What are the results of calcium and vitamin D deficiencies?
•
•
•
•
•
Simple dietary calcium deficiency usually has no symptoms, as calcium levels in the blood are tightly
controlled.3
Chronically low calcium intake or poor calcium absorption is one of the causes of decreased bone
mineral density resulting in osteopenia (lower than normal bone-mineral density), osteoporosis (very
low bone mineral density), and an increased risk of fractures.2
Medical problems causing hypocalcemia produce symptoms such as numbness and tingling in fingers,
muscle cramps, convulsions, lethargy, poor appetite and mental confusion.3
Vitamin D deficiency causes rickets in children and can lead to osteomalacia or osteoporosis in adults.4
Deficiencies of calcium and vitamin D have been studied in relation to increased risk of cancer,
cardiovascular disease, hypertension, diabetes, metabolic syndrome, falls and physical performance,
immune function, autoimmune disorders, infections, neuropsychological function, and preeclampsia.
Currently there is not enough evidence to clearly establish the effects of calcium or vitamin D on these
health conditions, or to make recommendations about requirements to prevent or manage these
conditions.3,4
How much calcium and vitamin D do Albertans get from food?
Calcium:
In Canadian populations there is a high prevalence of inadequate calcium intakes. The 2004 Canadian
Community Health Survey reported that the average daily intake of calcium from food among Albertans,
depending on age and gender, is 692 mg to 1297 mg.6 The only population groups that met the requirement
for calcium intake from food are males ages 9 to 30, and females ages 19 to 30. Females over 70 years had
the lowest intake of calcium from food—692 mg per day; the RDA for this group is 1200 mg per day from
food and supplements.
February 2013
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Nutrition Guideline
Calcium and Vitamin D
For Professional Reference Only
Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
Vitamin D:
Adequacy of vitamin D intake is difficult to assess because it is synthesized in the skin through sun exposure
as well as being absorbed from food. The Institute of Medicine assumed minimal sun exposure when
developing recommended intakes of vitamin D.1
The recommended intake of vitamin D is 600 IU to 800 IU per day (see the table of Dietary Reference
Intakes (DRI) in the Recommendations section above).The 2004 Canadian Community Health Survey
reported that the average daily intake of vitamin D from food by Alberta adults and children is 3.9 to 8.3 mcg
(156 to 332 IU) per day.6
What are the calcium and vitamin D recommendations for children and adolescents (2 – 18 years)?
For a summary of the recommended intakes of calcium and vitamin D, refer to the table in the
“recommendations” box at the beginning of this guideline.
These recommendations should apply in all areas of Alberta with no differentiation between northern and
southern parts of the province.
Calcium:
The Dietary Reference Intakes (DRIs) recommend children obtain the intakes of calcium listed in the
Recommendations section above.
Parents and caregivers should try to meet children’s calcium needs with food, because food provides many
nutrients that are not present in supplements.7 If calcium requirements cannot be met through diet,
supplements should be considered.
Vitamin D:
There is evidence that vitamin D deficiency exists in some Canadians,8,9,10,11,12,13,14 partly due to low levels of
sun exposure.
The DRI for children 1 to 18 years of age is 600 IU of vitamin D daily.1 To meet these DRIs, Nutrition
Services, Alberta Health Services recommends:
•
that children and adolescents include food sources of vitamin D,
and
•
that children and adolescents take 400 IU vitamin D per day as a supplement.
(See ‘Why is it recommended that all Albertans should take vitamin D supplements?’ section below.)
February 2013
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Nutrition Guideline
Calcium and Vitamin D
For Professional Reference Only
Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
What are the calcium and vitamin D recommendations for adults (19 years and over)?
For a summary of the recommended intakes of calcium and vitamin D, refer to the table in the
“recommendations” box at the beginning of this guideline.
These recommendations should apply in all areas of Alberta with no differentiation between northern and
southern parts of the province.
Calcium:
The Dietary Reference Intakes (DRIs) recommend that healthy adults obtain the intakes of calcium listed in
the Recommendations section above.
Osteoporosis Canada (2010) recommends that both men and women over age 50 (not just women) at risk
of or diagnosed with osteoporosis should have a total daily calcium intake of 1200 mg.15
There have been questions about a possible link between calcium supplements and an increased risk of
heart disease for adults (≥ 19 years). Data from some clinical trials suggest that calcium supplementation
(≥1000mg/day) may modestly increase the risk of cardiovascular events.5,16,17,18,19,20There does not seem to
be a risk or concern with calcium from food sources.19 Health risks are associated with intakes either below
or above the RDA.17,18
Adults should aim for a total calcium intake from food sources that meets the RDA for their age and gender
(see the Recommendations section above). Those people unable to meet their calcium requirements with
dietary sources should discuss supplement use with their health care provider.
Vitamin D:
For the recommended intakes of Vitamin D, refer to the table in the “recommendations” box at the beginning
of this guideline.
•
Nutrition Services, Alberta Health Services recommends:
o
that healthy individuals include food sources of vitamin D,
and
o
o
•
that adults 19 to 70 years take 400 IU vitamin D per day as a supplement
that adults over the age of 70 take 800 to 1000 IU vitamin D per day as a supplement
For adults at risk of fragility fractures or osteoporosis, the 2010 Osteoporosis Society of Canada
recommendations are:15
o
adults 19 to 50 years at low risk of vitamin D deficiency should take 400 to 1000 IU vitamin D per
day as a supplement
o
adults 51 years and older at risk of vitamin D deficiency: 800 to 1000 IU vitamin D per day as a
supplement. To achieve optimal vitamin D status many individuals may require up to 2000 IU per
day.
Individuals can discuss their calcium and vitamin D requirements with their physician or healthcare provider.
February 2013
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Nutrition Guideline
Calcium and Vitamin D
For Professional Reference Only
Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
Pregnancy and Lactation
The DRIs for calcium and vitamin D for pregnant and breastfeeding women are the same as guidelines for
non-pregnant women of the same age.1
What are the food sources of calcium?
Individuals should try to meet their calcium needs by eating food sources of calcium. Food sources
have other important nutrients in them not found in supplements, like protein, fibre, and antioxidants.
Food sources of calcium (mg = milligrams)
•
•
•
•
•
•
•
•
•
Best sources
About 300 mg of calcium
Milk, lactose-reduced milk, and
buttermilk, 1 cup (250 mL)
Milk, evaporated, undiluted,
½ cup (125 mL)
Skim milk powder, ⅓ cup
(75 mL)
Fortified soy, rice or almond
beverage, 1 cup (250 mL)
Nutrition supplement drink such
as Boost® or Ensure®,
1 cup (250 mL)
Hard cheese (cheddar,
mozzarella), 1½ oz (50 g)
Ricotta cheese, ½ cup
(125 mL)
Tofu made with calcium,
3.5 oz (105 g)
Plain yogurt, ¾ cup (175 mL)
•
•
•
•
•
•
•
Good sources
About 200 mg of calcium
Sardines, canned with bones, 4
Salmon, canned with bones, 3.5
oz (105 g)
Dried silver fish ½ oz (15 g)
Soup made with milk, 1 cup
(250 mL)
Fruit-flavoured yogurt, ¾ cup (175
mL)
Blackstrap molasses, 1 Tbsp
(15 mL)
Pudding made with milk,
½ cup (125 mL)
Sources
About 100 mg of calcium
• Almonds, Brazil nuts, ¼ cup
(60 mL)
• White beans, navy beans, and
soybeans, ½ cup (125 mL)
• Ice cream, ½ cup (125 mL)
• Frozen yogurt, ½ cup (125 mL)
• Cooked bok choy, ½ cup
(125 mL)
• Skim milk powder, 1 Tbsp
(15 mL)
• Cottage cheese, ¾ cup
(175 mL)
• Roasted soybeans, ¼ cup
(60 mL)
• Calcium-fortified orange juice, ½
cup (125 mL)
• Sea cucumber 1 oz (30 g)
• Seaweed 1 cup (250 mL)
• Dried day lily 1 oz (30 g)
Nutrient amounts from Canadian Nutrient File, 2010 21
What affects calcium absorption?
Foods rich in oxalic acid, phosphorus, and phytic acid may inhibit calcium absorption; however, the total
calcium content of the diet is more important for determining adequate intake than the bioavailability of
calcium from specific foods.2 Although high caffeine, protein, or sodium intakes may increase urinary losses
of calcium, high intakes of these substances do not require increases in calcium intake.2
For people who eat a variety of foods, these interactions probably have little or no nutritional consequence
and, furthermore, are accounted for in the calcium DRIs, which factor in differences in absorption of calcium
in mixed diets.3
February 2013
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Nutrition Guideline
Calcium and Vitamin D
For Professional Reference Only
Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
When should an individual take a calcium supplement?
Individuals are advised to meet their calcium requirements from food sources when possible, since these
foods provide a variety of necessary nutrients that are not present in calcium supplements.7
Adults should aim for a total calcium intake from food sources that meets the RDA for their age and
gender7,16
(See the Recommendations section, and the What are the calcium and vitamin D recommendations for
adults (19 years and over)? section above).
Those people unable to meet their calcium requirements with dietary sources should discuss supplement
use with their health care provider.
Individuals who may be at risk of low calcium intakes include:3
• Postmenopausal women—decreased estrogen production results in increased bone resorption and
decreased absorption of calcium from the gut.
• Amenorrheic women—amenorrhea (when menstrual periods stop, or fail to start at the appropriate age)
results from low levels of circulating estrogen. Low estrogen levels are occasionally due to anorexia
nervosa, or can be exercise-induced.
• People who eat little or no dairy products because of lactose intolerance, cow’s milk allergy, or food
preference.
• People who follow a vegan or vegetarian lifestyle and eat little or no dairy products.
Individuals may need to consult a Registered Dietitian to help improve their intake of calcium from food
sources.
Target total calcium intake from food and/or supplements should be the RDA for age
(See Recommendations section above).
What are some recommendations for taking calcium supplements?
Recommendations for taking calcium supplements:
•
Check the label of a supplement for:
o
The amount of elemental calcium. Elemental calcium is the amount of calcium that is actually
supplied by the supplement.
o
A Natural Product Number (NPN), Drug Information Number (DIN), or a Homeopathic Medicine
Number (DIN-HM). These are 8-digit numbers assigned to products that have been assessed by
Health Canada and found to be safe, effective and of high quality under their recommended
conditions of use.22,23
•
Calcium supplements are best absorbed when no more than 500 mg elemental calcium is taken at one
time.3 An individual who takes 1000 mg calcium per day could split the dose and take 500 mg at two
separate times in the day.
•
Calcium can interfere with certain medications.24 The Health Canada calcium monograph recommends
taking calcium supplements a few hours before or after taking other medications.25 Individuals should
talk with their pharmacist or physician to determine the best time of the day to take their medications
and/or supplement.
February 2013
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Nutrition Guideline
Calcium and Vitamin D
For Professional Reference Only
Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
•
Individuals already taking a multivitamin or calcium supplement should check the amount of calcium
they contain and then take a separate calcium supplement to obtain the rest. Individuals should ensure
they do not exceed upper limits for other vitamins and minerals. For example, taking more than one
multivitamin daily can result in vitamin A levels above the tolerable upper limit.
Two of the most common forms of calcium supplements are calcium citrate and calcium carbonate.
• Calcium carbonate is commonly available and is less expensive. It is best absorbed when taken with
food, as gastric acid is needed for its absorption.3
• Calcium citrate3 can be taken any time—it is absorbed equally well when taken with or without food.
Calcium citrate is often recommended for older populations because they may have lower amounts of
gastric acid and gastric acidity is not needed for its absorption. Calcium citrate may also be useful for
people with achlorhydria, inflammatory bowel disease, or absorption disorders. Calcium citrate
supplements are often more expensive than other calcium supplements.
The amount of elemental calcium in these two types of supplements is different. Calcium carbonate contains
40% calcium, while calcium citrate contains 21% calcium. This means that calcium citrate tablets often have
lower amounts of elemental calcium, and so more tablets are required to meet the daily dose.
What are the food sources of vitamin D?21
Food sources of vitamin D (IU = International Units)
Best sources
More than 200 IU per serving
• Fish and shellfish, 2.5 oz
(75 g)*
o Oysters
o Herring
o Salmon
Good sources
About 100 IU per serving
• Milk, lactose-reduced milk, and
buttermilk, fortified with vitamin D,
1 cup (250 mL)
• Fortified soy, rice or almond
beverage, 1 cup (250 mL)
• Skim milk powder, ⅓ cup (75 mL)
• Fish and shellfish, 2.5 oz (75 g)*
o
Sardines
o
Halibut
Sources
About 50 to 100 IU per serving
• Margarine, 1 Tbsp (15 mL)
• Eggs, 2
• Nutrition supplement drinks
such as Boost® or Ensure®,
1 cup (250 mL)
• Mackerel, 2.5 oz (75 g)*
Nutrient amounts from Canadian Nutrient File, 2010
*Vitamin D levels in fish vary. For example, farmed salmon has less vitamin D than wild salmon.
Why is it recommended that all Albertans take vitamin D supplements?
The recommended intake of vitamin D is 600 to 800 IU per day (see the table of Dietary Reference Intakes
(DRI) in the Recommendations section above).The 2004 Canadian Community Health Survey reported the
average daily intake of vitamin D from food by Alberta adults and children is 3.9 to 8.3 mcg (156 to 332 IU)
per day.6 It is widely agreed that consuming adequate amounts of vitamin D from dietary sources is
difficult.26,27
February 2013
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Calcium and Vitamin D
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Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
These intake levels mean that most Albertans get less than half of their recommended vitamin D
requirements from food. Without supplementation of vitamin D, Albertans over 1 year of age would be
expected to make up the remaining 268 - 444 IU/day of the DRI through unprotected sun exposure. In
Canada, depending on the time of day, the time of year, how much skin is covered by clothing or sunscreen,
and the degree of skin pigmentation, it may not be possible to achieve this degree of vitamin D synthesis.26
According to the Guidelines Committee of the Scientific Advisory Council of Osteoporosis Canada sunlight is
inadequate to induce the synthesis of sufficient vitamin D during the winter at any latitude north of 35°N.26
The entire province of Alberta is north of 45°N therefore there is little evidence to support differentiating
between northern and southern parts of the province.
In view of low levels of vitamin D intake from food 26,27 and probable low levels from sun exposure, Nutrition
Services, Alberta Health Services recommends vitamin D supplementation for healthy Albertans.
(See ‘What are the calcium and vitamin D recommendations for children and adolescents’ and ‘What are the
calcium and vitamin D recommendations for adults’ sections above).
What are some recommendations for taking a vitamin D supplement?
•
•
•
•
•
Look for a Natural Product Number (NPN), Drug Information Number (DIN), or a Homeopathic Medicine
Number (DIN-HM).
Vitamin D supplements are available in two forms: vitamin D2 or vitamin D3. Both forms appear to be
effective in maintaining serum vitamin D levels and improving bone health.4,28 Osteoporosis Canada
recommends vitamin D3 for vitamin D supplements.15,26
Vitamin D2 is from non-animal sources and therefore appropriate for vegetarian or vegan diets.4
Individuals should not exceed the Upper Limit for vitamin D intake as recommended by the DRIs, unless
advised and monitored by a physician. The Upper Limits for vitamin D are listed in the
Recommendations section above.
Individuals already taking a multivitamin or calcium supplement should check the amount of vitamin D
they contain and then take a separate vitamin D supplement to obtain the rest. Individuals should
ensure they do not exceed upper limits for other vitamins and minerals. For example, taking more than
one multivitamin daily can result in vitamin A levels above the tolerable upper limit.
Who should have their serum vitamin D level tested?
Not everyone needs their serum vitamin D level tested. The Institute of Medicine,1 the Scientific Advisory
Council of Osteoporosis Canada (2010),15,26 and the 2011 Endocrine Society Clinical Practice Guideline27
state that it is unnecessary to do routine screening on those who are otherwise healthy.
Alberta’s Toward Optimized Practice (TOP) Guideline for Vitamin D Testing and Supplementation,
(October 2012), states that routine vitamin D testing is not warranted in the general population (those not at
high risk of deficiency), and that testing is not necessary before or after starting vitamin D supplementation.29
February 2013
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Nutrition Guideline
Calcium and Vitamin D
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Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
The TOP guideline lists the infrequent clinical situations where testing of serum 25-hydroxy vitamin D or
serum 1, 25-dihydroxy vitamin D is indicated. Indications for serum 25-hydroxy vitamin D testing include
significant renal and liver disease; osteomalacia, osteopenia or osteoporosis; malabsorption syndromes;
hypo or hypercalcemia; hypo or hyperparathyroidism; medications affecting vitamin d metabolism.29
The guideline lists further indications; it is available at:
http://www.topalbertadoctors.org/cpgs.php?sid=18&cpg_cats=91&cpg_info=61
An Alberta Health Services Laboratory Bulletin (December 12, 2012) states that 25-hydroxy vitamin D
measurements will be limited to one per 90 day period per patient.
http://www.albertahealthservices.ca/LabServices/wf-lab-bulletin-25oh-vitamin-d-testing.pdf
What are sources of calcium and vitamin D for people with lactose intolerance?
Lactose intolerance is the inability to digest lactose, the sugar in milk and milk products.30 Lactose
intolerance happens when an individual produces low amounts of the enzyme lactase. Individuals with
lactose intolerance differ in the amounts and types of lactose-containing foods they are able to tolerate.
The following tips can help lactose-intolerant individuals obtain adequate calcium and vitamin D from their
diet:30
•
Spread the intake of milk products throughout the day.
•
Eat smaller amounts of milk products at one time.
•
Add lactase enzyme to food. The enzyme is available as pills or drops from pharmacies.
•
Try milk that has had lactase enzyme added during processing. This milk is sold in most major grocery
stores. Look for brands such as Lactaid® or Lacteeze®.
•
Soy or rice beverages are naturally lactose free. Choose products fortified with calcium and vitamin D.
•
Hard cheese is often better tolerated due to lower lactose levels.
•
Yogurt contains lactose; however, bacterial cultures in yogurts that have active and live cultures convert
lactose to lactic acid in the gut. Therefore, some individuals with lactose intolerance can tolerate yogurt
with live cultures. Frozen yogurt does not contain bacterial cultures, so it may not be as well tolerated.
Only a physician can diagnose true lactose intolerance.
Are there any dietary components, other than calcium and vitamin D, which can affect bone health?
Other dietary components which are known to affect bone health include but are not limited to:31
Protein:31 Maintaining adequate protein intake, along with adequate calcium intake, is important for bone
health. Adequate protein intake is particularly important for older adults for reduction of bone losses, and for
prevention of sarcopenia and falls. Excess protein intake does not appear to provide a clear advantage and,
in some cases, can negatively affect bone health.4
Caffeine: Moderate daily caffeine intake at a dose up to 400 mg per day is not associated with any adverse
effects on bone status and calcium balance in individuals with adequate calcium intake.31 Caffeine may
induce a short-term increase in calcium excretion and may modestly decrease calcium absorption.2 Excess
February 2013
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Calcium and Vitamin D
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Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
caffeine consumption (more than 4 cups brewed coffee per day or more than 400 mg caffeine) has been
associated with increased hip fracture risk.31 Available evidence does not warrant different calcium intake
recommendations for individuals with varying caffeine intakes.2
Sodium: Excess dietary sodium (more than 2300 mg per day) should be avoided as it may reduce bone
mineral density in adults.31
Refer to Guidelines: Sodium; General Healthy Eating for Children and Adults
What can individuals do, besides improve their diet, to reduce risk of osteopenia and osteoporosis?
Exercise improves quality of life (physical functioning and pain), muscle strength and balance of individuals
with osteoporosis, although there is no conclusive evidence that it reduces fractures.15
The Osteoporosis Canada 2010 Clinical Practice Guidelines for the Diagnosis and Management of
Osteoporosis in Canada suggest that:15,32
• those with osteoporosis or at risk include weight bearing, balance and strengthening exercises
• individuals who have had vertebral fractures include exercises which enhance core stability
• exercises for those at risk of falls focus on balance (e.g. tai chi), or on balance and gait training.
• interventions focusing on exercise for community-dwelling older individuals improve balance and reduce
falls
Are there any handouts on calcium and vitamin D that I can use with my clients?
Refer to approved provincial Alberta Health Services bariatric nutrition handouts to support patient
education. For more information, contact [email protected]
February 2013
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Calcium and Vitamin D
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Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
References
1.
Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D [Internet]. 2010 Nov 30 [cited 2013
Jan 18]. Available from: http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-VitaminD.aspx
2.
Otten JJ, Hellwig JP, Meyers LD. Dietary reference intakes: the essential guide to nutrient requirements.
Washington, DC: National Academies Press; 2006.
3.
Office of Dietary Supplements, National Institutes of Health. Dietary Supplement Fact Sheet (Health
Professional): Calcium. Reviewed 2012 Aug 1 [cited 2013 Jan 18]. Available from:
http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/
4.
Office of Dietary Supplements, National Institutes of Health. Dietary Supplement Fact Sheet (Health
Professional): Vitamin D. Reviewed 2011 Jun 24 [cited 2013 Jan 18]. Available from:
http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
5.
Wang L, Manson JE, Sesso HD. Calcium intake and risk of Cardiovascular Disease: A review of prospective
studies and randomized clinical trials. Am J Cardiovasc Drugs. 2012;12(2):105-116
6.
Health Canada. Canadian Community Health Survey Cycle 2.2, Nutrition (2004). Nutrient Intakes from Food:
Provincial , Regional and National Summary Data Tables, Volume 1. Revised 2009 Feb. Ottawa: Publications
Health Canada; 2009.
7.
Dietitians of Canada. Osteoporosis: Key Practice Points. In: Practice-based Evidence in Nutrition [PEN]. 2012
Mar 23 [cited 2013 Jan 29]; Available from:
http://www.pennutrition.com/KnowledgePathway.aspx?kpid=553&pqcatid=144&pqid=19215. Access only by
subscription.
8.
Weiler H, Fitzpatrick-Wong S, Veitch R, Kovacs H, Schellenberg J, McCloy U, et al. Vitamin D deficiency and
whole-body and femur bone mass relative to weight in healthy newborns. CMAJ. 2005;172(6):757-61.
9.
Haworth JC. Rickets still affects Canadian children. CMAJ. 1995 Sept 15;153(6):740-1.
10.
Binet A, Kooh SW. Persistence of vitamin D-deficiency rickets in Toronto in the 1990s. Can J Public Health.
1996;87(4):227-30.
11.
Lebrun JB, Moffatt MEK, Mundy RJT, Sangster RK, Postl BD, Dooley JP, et al. Vitamin D deficiency in a
Manitoba community. Can J Public Health. 1993;84(6):394-6.
12.
Canadian Paediatric Society. Canadian paediatric surveillance program - 2005 results [document on internet].
2005 [cited 2008 Aug 21]. Available from: http://www.cps.ca/English/surveillance/CPSP/Studies/2005Results.pdf
13.
Hollis BW, Wagner CL. Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin
Nutr. 2004;79:717-26.
14.
Ward LM. Vitamin D deficiency in the 21st century: a persistent problem among Canadian infants and mothers.
CMAJ 2005;172(6):769-70.
15.
Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 clinical practice guidelines
for the diagnosis and management of osteoporosis in Canada: summary. Can Med Assoc J. 2010;182(17):18641873. Available from: http://www.cmaj.ca/content/early/2010/10/12/cmaj.100771.full.pdf+html.
16.
Dietitians of Canada. Cardiovascular Disease Evidence Summary. In: Practice-based Evidence in Nutrition [PEN].
2012 Aug 29 [cited 2013 Feb 4]; Available from:
http://www.pennutrition.com/KnowledgePathway.aspx?kpid=2671&trid=3489&trcatid=42. Access only by
subscription.
17.
Xiao Q, Murphy RA, Houston DK et al. Dietary and Supplemental Calcium Intake and Cardiovascular Disease
Mortality. The National Institutes of Health–AARP Diet and Health Study JAMA Intern Med. 2013;E1-E8.
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Calcium and Vitamin D
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Nutrition Guideline
Calcium and Vitamin D
Applicable to: Nurses, Physicians and Other Health Professionals
18.
Michaëlsson K, Melhus H, Warensjö Lemming E, Wolk A, Byberg L. Long term calcium intake and rates of all
cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ 2013;346:f228.
Available from: http://www.bmj.com/content/346/bmj.f228
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February 2013
Page 3.2.1.12
Nutrition Guideline
Calcium and Vitamin D
Copyright © (2013) Alberta Health Services. All rights reserved. These materials may not be changed without written permission from [email protected].
These are intended for general information only; they are provided on an "as is", "where is" basis and are not meant to replace individual consultation with a healthcare provider or
dietitian. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.