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Purpose

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. Purpose. Review highlights contained within the report Share preliminary implementation plans. Scope of IOM Committee’s Work.

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  1. Health Canada Update:Dietary Reference Intakes for Calcium and Vitamin DHélène Lowell, RDOffice of Nutrition Policy and PromotionOSNPPH – June 3rd, 2011

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

  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. 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. 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. 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. Vitamin D

  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. Calcium

  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. 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. CCHS Calcium Intakes E: Data with a coefficient of variation (CV) from 16.6% to 33.3%; interpret with caution.

  13. 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

  14. CCHS Vitamin D Intakes

  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. 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

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

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