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What’s next for the Dietary Reference Intakes for Bone Metabolism Related Nutrients beyond Calcium: Phosphorus

, Magnesium, Vitamin D and Fluoride?
Christine Bergman1, Darlene Gray-Scott2, Jau-Jiin Chen3, Susan Meacham4

Christine Bergman1 and Susan Meacham4 are Associate Professors in the Department of Food and Beverage Management1 and the School of Life Sciences4. Jau-Jiin Chen3 is an Assistant Professor in the Department of Nutrition Sciences, and Darlene Gray-Scott2 completed a Master’s degree in the Department of Health Promotion, all at the University of Nevada Las Vegas. Address correspondence to: Susan L. Meacham, 4505 Maryland Parkway, Box 454004, Las Vegas, NV 89154-4004, fax 702-895-3915, email

Abstract The science supporting the Dietary Reference Intakes (DRI) for phosphorus, magnesium, vitamin D, and fluoride was examined in this review. Along with the previous article on calcium in this series both of these reviews represent all the DRI for nutrients considered essential for bone metabolism and health, as reported in the Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (Institute of Medicine, Food and Nutrition Board, 1997). The Recommended Dietary Allowances (RDA) or adequate intake (AI), and the tolerable upper intake level (UL) were recommended for each of these essential nutrients. For adults and in the case of fluoride, for infants as well, UL were calculated since all of these nutrients have the potential for mild to detrimental side effects. Dietary intake data and controversies regarding the role these nutrients may play in other chronic diseases have also been discussed. Advances and controversies reported since publication of the DRI for these nutrients were also addressed in this review. A recent Dietary Reference Intake Research Synthesis Workshop report identified an extensive range of suggested future research directions needed to improve our understanding of these bone related nutrients and their contributions to human health.

Key words: Dietary Reference Intakes, Recommended Dietary Allowances, Adequate Intakes, Tolerable Upper Intake Levels, Bone Nutrients, Phosphorus, Magnesium, Vitamin D, and Fluoride

and the youngest life stages for phosphorus and magnesium in 1997. Since an Adequate Intake (AI). magnesium. and not a Recommended Dietary Allowance (RDA). Magnesium. some consideration was also given to data describing potential biological roles for these nutrients in the prevention of other chronic diseases. vitamin D and fluoride. examined the role of these nutrients in the development and maintenance of bones and teeth. This review summarizes the work of the FNB’s DRI committee. Phosphorus. and Fluoride (Institute of Medicine. Vitamin D. This was not surprising since chronic disease is known to result from complex interactions among genetic. Food and Nutrition Board (FNB). was set for vitamin D and fluoride. the controversies that surrounded the . phosphorus. as well as the other bone related nutrients.Introduction Dietary Reference Intakes (DRI) The Dietary Reference Intakes for Calcium. At the time. The science-based evidence used to establish the DRIs for calcium. But relatively little emphasis was given to these data since the FNB were unable to develop conclusions that could be agreed upon. and other environmental factors. ten years later. summarizes the latest recommendations and what has been learned about bone related nutrients since the FNB report was published. The review of the latest dietary requirements of some nutrients important to bones and teeth. it is time to revisit. and the FNB. 1997) were values calculated with the goal of maintaining health and avoiding potential risks from nutrient toxicity. along with a previous report on dietary calcium. dietary. its subcommittee on upper reference levels of nutrients. its expert panel on calcium. A panel of scientists and nutrition experts from the United States and Canada developed the dietary recommendations based on analysis of the currently available scientific literature (see Figure 1).

which is highly hormonally regulated and involving bone. The remainder of body phosphorus is in the soft tissues. acts as a temporary storage and transfer of energy. including school lunch budgets. Unlike calcium. What science based evidence is needed? What have we learned since making our last recommendation? Also. phosphorus occurs as phospholipids. considering the economic. unlike calcium. Also.S. the resulting consequences of severely . and educational materials. Inadequate phosphate intake can result in low blood levels of phosphorus and depleted levels in extracellular fluid. blood.original “second” tier recommendations for these essential bone related nutrients. In tissue membranes. Traditionally. the method of phosphorus regulation is primarily through the kidney (Lotz et al. and is a cofactor activates many enzymes. and extracellular fluid. However. persons recovering from prolonged illnesses or receiving parenteral nutrition for extended periods of time may be at risk (Lotz et al. menus. 1968).. Inadequate phosphorus intakes in the U. and in other capacities phosphorus helps to maintain pH.. what interactions do these nutrients have with calcium? There are many entities that have a “stake” in knowing which way a committee might go with the next revisions? Up? Down? Or stay the same? Potential changes may impact many. in the human body is its structural role in bone as a component of hydroxyapatite. there is no adaptive mechanism for differential absorption rates with varying dietary intake. hospital menus. are rarely a concern. marketing. as phosphorus is available in many foods thus these deficiencies are seldom seen. Phosphorus Overview The primary function of phosphorus. 1968). which accounts for 85% of the phosphorus in the body. intestines and kidney. as carbon phosphate. pharmacological and educational effort invested in bone health.

However. were used. rickets. AIs are available for infants. by as much as 66% for infants (National Research Council. In these women. While phosphorus intakes are often two times the recommended intakes. if also receiving anabolic osteoporosis treatment modalities that require a positive phosphorus balance. phosphorus recommendations for all other life-stage and gender groups have been lowered. paresthesias.and hyperphosphatemia can result in dysfunction or disease. bone pain. The current DRI are slightly higher. estimates based on a factorial approach. confusion. or death. calcification of the kidney. muscle weakness. More recently concerns regarding high calcium supplementation have been purported to bind food phosphorus inhibiting intestinal absorption. 10-15% of older women consume less than 70% of the recommendation. while RDAs are available for the remaining life-stage groups (Table 1). 1989).depleted body phosphorus are anorexia. and reduction in calcium . 2004). osteomalacia. the panel concluded that the level required to maintain serum levels within an optimal range is the most logical indicator of phosphorus nutriture. Phosphorus Recommendations Phosphorus dietary recommendations were set using phosphorus balance studies and serum inorganic phosphate concentrations. ataxia. Committee on Dietary Allowances. Tolerable upper intake levels have been set for phosphorus because of the reported complications resulting from hyperphosphatemia: alteration in hormonal control of calcium. than previous recommendations for boys and girls 11 to18 years of age and young pregnant and lactating women 14-18 years of age. anemia. Since these values have not been established for infants and children. Since hypo. increased porosity of the skeleton. 50 mg. recognizing the need for phosphorus during growth. depressed immune function. taking high calcium supplements may exacerbate phosphorus deficiencies (Heaney.

These questions appear to be . 2006). Based on the evidence the panel concluded that the potential for phosphorus to interfere is not of concern as long as calcium intake is adequate. Metastatic calcification can occur in individuals with end-stage renal disease whose phosphorus levels are not controlled (Institute of Medicine FNB. For phosphorus there is a need to define the intake needed to optimize bone accretion in children 1to 18 years. 1997). the panel concluded that these effects can be minor. The questions that Sax indicates need to be answered include: (1) Do diets with a low calcium-to-phosphorus ratio affect bone density in children and adolescents differently than in adults and (2) do diets with a low calcium-to-phosphorus ratio affect bone density in human females differently than in males? These questions are stated to stem from reliance of the FNB on studies performed using adult males for phosphorus to calcium ratio recommendations for adult women. For children and adults serum values should be assessed to define the relationship between phosphorus intake and phosphorus levels in blood. 1997). as discussed previously. adolescents and children. the committee concluded that high phosphorus intakes do not result in negative calcium balance or increased bone resorption (Institute of Medicine FNB. A recent workshop reviewed the findings of the DRI committees and suggested research recommendations. A critical review by Sax (2001) has made suggestions as to research needed prior to unequivocally being able to state that the ratio between calcium and phosphorus intake does not impact bone health. There has also been concern about high dietary phosphorus interfering with calcium absorption. Though high phosphate levels have the potential for altering calcium levels in the body. particularly if calcium intake is adequate and thus do not provide evidence for estimating the UL. In humans. (Dietary Reference Intakes Research Synthesis: Workshop Summary.absorption.

Phosphorus is considered a limiting nutrient in the biosphere. the DRI panel still concluded that according to national intake data. meat. Given this uncertainty. and fish. 2004). nuts. ranging from . 1997). Phosphorus content of some common foods is presented in Table 2.especially worth investigating since women and children today are consuming more phosphoruscontaining soft drinks and less calcium-containing milk than 25 years ago (French et al. however. Another concern previously considered for infants was whether or not to determine adequate calcium to phosphorus ratio for infants. The DRI panel reviewed the literature and concluded that there was little or no evidence to support setting a ratio for the dietary relationship between these nutrients for healthy infants (Institute of Medicine FNB. Thus. USDA.. 1997). There has been uncertainty about the phosphorus content in highly processed foods. cheese. the primary sources of dietary phosphorus for most adults are readily available and abundant in the food supply. bran. eggs. infant formulas contain considerably greater amounts of phosphorus than in human milk to offset the lower absorption rate. Economic Research Service. which today are more abundant than they were 20 years ago. Dietary Intake and Sources of Phosphorus It has been estimated that approximately 20-30% of daily phosphorus intake comes from processed foods and soft drinks. 2003. Because of the efficiency of absorption. Factors Affecting Infant Phosphorus Requirements The phosphorus in cow’s milk and soy formulas is absorbed with more difficulty by human infants than that absorbed from breast milk. To compensate for this physiological difference. bread. milk. cereal. questions arise regarding the reliability of phosphorus estimates in nutrient databases (Institute of Medicine FNB. mean intakes for phosphorus seemed adequate for most adults.

2005. 2003). One of the largest. 20 and 10% of recommendations were fed to rats. and tumor necrosis factor-alpha increased. trabecular bone volume decreased. Diets rich in potassium and magnesium are associated with lower blood pressure levels. 2004). and bone strength. 1997. Its primary functions include maintenance of muscle and nerve function.55% to 80% in the intestine. and its abundance in foods. Rude et al. Conversely. 1997). phosphorus deficiencies are not common (Heaney. Magnesium Magnesium is an essential mineral that is needed for hundreds of metabolic reactions in the body. sodium. Magnesium and Disease Bone. osteoclast number increased. including magnesium. There is considerable evidence that magnesium may play an important role in regulating blood pressure. 2004). magnesium supplementation may improve bone density (Institute of Medicine FNB. while the rest is in other tissues and organs (Institute of Medicine FNB. a dynamic and complex structure. multi-site studies to support this concept is the DASH trial (Ascherio . potassium-ATPase activity. This should also hold true for some individuals ingesting high calcium supplements as carbonates or citrates. 2006) demonstrated the role of dietary magnesium depletion in bone health when intakes at 50. normal cardiac rhythm. Magnesium deficiency may contribute to osteoporosis because of its metabolic influence on calcium. is composed of numerous minerals. (2004. and if they remain attentive to their meat and dairy intake. particularly when taking advantage of bone rebuilding therapies low intakes of phosphorus (Heaney. nucleotide synthesis. Sardesai. More than half of the magnesium in the body is combined with calcium and phosphorus in the bone.

et al. it is the most readily available technique and has been commonly used in research trials. and fruits and vegetables can provide this nutrient profile. low-fat dairy foods. 1998. potassium. Studies designed to evaluate this hypothesis are needed. Evaluation and Treatment of High Blood Pressure. 1997. the beneficial effect of long-term coffee consumption on the development of type-two diabetes has proposed to be due to additional magnesium consumption (Qureshi and Melonakos. These studies indicated hypertension can be improved using a diet low in sodium.. 1999. The FNB reported that magnesium likely plays a role in the release and action of insulin (Institute of Medicine FNB. Schulze and Hu. amongst other compounds. The DRI are slightly higher or lower than the . Similarly. Similar to phosphorus. NIH & NHLBI.. including various other methods of determining magnesium status the panel calculated an RDA for magnesium (Table 1) (Institute of Medicine FNB. others have discussed the possible preventive effect of magnesium on type-two diabetes development. Serum magnesium may not reflect intracellular magnesium content. 1999. Diets rich in lean proteins. 1999). nor has it been validated as a reliable indicator of magnesium status. while higher dietary intakes and plasma levels of magnesium have been associated with a lower risk of heart disease and stroke (Ford. Magnesium deficiency may be associated with cardiac abnormalities and stroke. Since the FNB report. Taking into account all available literature.. Sacks et al.. total and saturated fat. For example. 1997). 1998. However. 1999. 1996). Magnesium Recommendations Several indicators have been used in the literature to estimate magnesium requirement. hypomagnesemia has been reported in individuals with poorly controlled type-one and type-two diabetes. and calcium. and high in magnesium. 2005). Liao et al. and RDA for all other groups. Joint Committee on Prevention. Svetkey et al. 1997). Detection. AI are reported for infants.

Institute of Medicine FNB. the panel has set UL for magnesium (Table 1). 2005). It appears however. while it is slightly lower than the RDA for women. the increased excretion does not appear to be detrimental as long as intakes are adequate (Institute of Medicine FNB.previously reported RDAs (National Research Council. 1989). Diets very high in phosphate or fiber.. Dietary Intake and Food Sources of Magnesium The panel reported mean dietary intakes for adult men to be close to the RDA. loop and thiazide diuretics. the cancer drug Cisplatin and some antibiotics such as Gentamicin. 1997). may decrease intestinal absorption of magnesium. Committee on Dietary Allowances. However. 1997). Alcohol. while high protein intakes may increase renal excretion of the mineral. Other factors affecting magnesium requirement involve nutrient-nutrient interactions. Additional Factors Affecting Magnesium Requirement Ingestion of certain substances may cause excessive renal losses of magnesium. People with poorly controlled diabetes may also have increased magnesium loss and may need to be evaluated by their physician (Gropper et al. 1997). and thus phytates. Amphotericin. that calcium has a negligible effect on magnesium absorption. Low protein intakes may result in impaired magnesium absorption. 1992. High doses of magnesium can have a laxative effect or in more severe cases can result in kidney failure (ADA. and Cyclosporin may increase magnesium loss and require a patient to be prescribed magnesium supplements. Because of the potential effects of toxicity. . Intakes tend to decline for individuals after the age of 70 (Institute of Medicine FNB. Any disease that results in malabsorption may also require additional magnesium intake.

and some whole grains and seafoods. Other good sources include nuts. serum values may not be the best indicators of magnesium status. 25dihydroxy cholecalciferol) and then affect metabolic functions in the small intestine. Likewise. cocoa. Since the quantity in most foods is relatively small. tea.. studies are needed to identify associations between magnesium intake and chronic diseases. The active form of vitamin D promotes the absorption of calcium in the small intestine and aids in bone mineralization with a number of other nutrients and hormones. or misshapen bones referred to as rickets in children and osteomalacia in adults (Garland et al. activated in the liver (25-hydroxy cholecalciferol) and kidneys (1. Future research is needed to identify the magnesium intake needed for optimal accretion of bone in children and for the preservation of bone in adults.The chlorophyll molecule contains magnesium and therefore green vegetables are a rich source.. seeds. Magnesium content is generally low in processed foods. soft. 1985). Vitamin D Vitamin D. Also. and hard water (Garland et al. it is wise to eat a variety of magnesium-rich foods on a regular basis. i. in addition to a number of beverages such as coffee. . Inadequate amounts of vitamin D can result in thin. hypertension. brittle. legumes. 1985). cardiovascular disease and diabetes. Magnesium content of some common foods is presented in Table 3.e. commonly recognized as a fat soluble vitamin is also referred to as calciferol and calcitriol. Some question whether vitamin D is a true hormone since it can be synthesized in the skin from sunlight. The vitamin plays an important role in a hormone-like fashion. maintaining serum calcium and phosphorus concentrations by enhancing the efficiency of absorption in the small intestine. thus research is needed to identify a valid and accurate assessment protocol for magnesium (Dietary Reference Intakes Research Synthesis: Workshop Summary.. 2006).

1999. AIs are reported for all lifestage groups. At this time it is not prudent to promote cancer prevention by advising individuals to take vitamin D. 1990). Furthermore. The amount of vitamin D required for optimal calcium metabolism and bone health is also complicated by the synthesized of the vitamin in skin with sunlight exposure. Vitamin D Recommendations The panel concluded that the best indicators for determining vitamin D nutriture are serum levels and the evaluation of skeletal health. More clinical trials need to be completed in order to establish a stronger association between vitamin D and cancer. is highly variable (Institute of Medicine FNB. there is a tolerable upper intake set for Vitamin D. the vitamin D content in foods. In children serum levels of vitamin D and other hormones were considered when the daily intake recommendations to prevent rickets were determined. a fat soluble vitamin with tolerable upper levels set for daily intakes. and. The AI and UL for vitamin D are presented in Table 1. Konety et al.Vitamin D and Cancer Epidemiological data suggest that vitamin D deficiency may be associated with an increased risk of developing colon.. As with other bone related nutrients discussed. Both serum concentrations of the vitamin are not good indicators of adequacy since the short half life and tight regulation by other factors modulate serum concentrations. breast. 2003. The current DRI are lower than the previous RDA (National Research Council. Conservative intakes are advised to prevent hypervitaminosis potentially resulting in . 1997). including government-mandated fortification of milk. The DRI for this group is two (51-70y) to three (>70y) times greater than the previous RDA of 5 µg/day. 2000. Sardesai. Schwartz and Hulka. 1989) except for individuals over the age of 50 years.. Committee on Dietary Allowances. Mahan and Escott-Stump. prostate cancer (Garland et al. 1990.

Recently. Other reported side effects include anorexia.. 1997). glomerular filtration rate and renal tubule reabsorption are decreased and calcification of soft tissues has been reported. Through a strong singular voice they shared their intention by writing an editorial stating that current findings are supporting higher recommendations for dietary intakes of vitamin D than are currently consumed (Vieth et al. and vomiting (Institute of Medicine FNB. a collectively written editorial shared the opinions of all the major vitamin D researchers worldwide. 2007). nausea. These patients may need to increase vitamin D intake with food or supplements (Sato et al. Whipple’s disease.hypercalcemia leading to a host of debilitating effects. Often patients with numerous inflammatory medical conditions require the chronic use of corticosteroid medications to manage their symptoms. placing the elderly at risk for vitamin D deficiencies (Wardlaw. 1998). Many people with Alzheimer’s disease have an increased number of hip fractures. They proposed that the dietary intakes of vitamin D are currently. Other conditions that are associated with intestinal malabsorption of vitamin D are Crohn’s disease. 2003). and sunlight deprived. 1990). and possibly absorption from the small intestine. The body’s mechanism to concentrate urine is impaired in the kidney. and Tropical Sprue (Lukert and Raisz.. the potential side effects of a drug-nutrient interaction include decreased calcium absorption and possible impairment of vitamin D metabolism. This population may also benefit from increased vitamin D intake (O'Dell and Sunde. Consequently. Factors Affecting Vitamin D Requirement Vitamin D synthesis in skin declines with advancing age. possibly because they are homebound or institutionalized. Vitamin D Intake and Sources . 1997). too low.

Clinical Significance of Fluoride Fluoride is not directly associated with diseases due to deficiencies or toxicities (O'Dell and Sunde. and cereals are fortified. If sun exposure is limited by either time (less than 10-15 minutes per day) or environmental conditions. Other foods like milk. Fluorohydroxyapatite significantly .some fish liver oils. smog. and sunscreens. Clinically. 1997).Vitamin D intake is difficult to assess because of the variable amounts in fortified foods and because some of the national surveys do not include vitamin D. Fluoroapatite is important for hardening tooth enamel and contributes to the stability of bone mineral matrix. infant formulas. the primary site of absorption for most nutrients (O'Dell and Sunde. Fluoride absorption is rapid. flesh of some fatty fish. with absorption continuing in the small intestine. Fluoride About 95% of body fluoride is found in bones and teeth (O'Dell and Sunde. When consumed with foods and beverages. 1997). 1997). Fluoride has some enzyme related effects in soft tissue enzymes but the physiological significance of these actions is not known. uniquely diffusing across the stomach wall into the blood. skin color. 1997). fluoride has a high affinity for the tissue of bone and teeth. it is important to consume foods or supplements in amounts consistent with the current AI (Institute of Medicine FNB. cloud cover. The ability to make vitamin D from sunlight depends on season. and eggs from hens fed vitamin D. fluoride complexes with proteins and other minerals such as calcium and magnesium reducing absorption to about 50-80%. Vitamin D occurs naturally in few food sources. time of day. latitude. Fluoride is present in the body as a trace element and is generally 100% absorbable when consumed as sodium fluorosilicate in fluoridated water or as sodium fluoride or monofluorophosphate in toothpaste or tablets.

Aluminum (particularly Al in antacids). Acute toxicities present with nausea. These effects can not be reproduced by any of the other 25 trace elements found in tooth enamel. acidosis. Like most minerals death has been reported at excessive ingestion levels. Sodium chloride decreases skeletal uptake of fluoride. the data are strong on risk reduction. Dietary proteins and fats have been reported to improve fluoride absorption. and possibly nerve and muscle function. vomiting. The AI is the intake value that reduces the occurrence of dental caries maximally in a group of individuals without causing unwanted side effects. 1997). 2005). With fluoride. The benefits of fluoride for children during tooth formation are best at preeruptive stages of development.3 mg/d for children 1 to 3 years to 10 mg/d for children older than 8 years and adults. Fluoride Recommendations The new DRIs have developed an adequate intake recommendations (Table 1) and upper intake levels for fluoride. alters bone. Chronic toxicity. thus driving the decision to adopt an AI as the reference value (Institute of Medicine FNB. and cardiac arrhythmias. Phosphate and sulfate increase fluoride uptake. resulting in fluorosis. but the evidence upon which to base an actual requirement is scant. diarrhea. magnesium and chloride reduce fluoride uptake and uses..reduces the likelihood of enamel dissolution by acids produced by cariogenic bacteria. lifetime benefits are derived from the effects of fluoride on the remineralization of surface enamel. Factors Affecting Fluoride Requirements Interactions of fluoride with other nutrients have been reported (Gropper et al. The tolerable upper intake level for fluoride ranges from 1. kidney. calcium. The most common manifestation of excess fluoride is dental fluorosis or mottling of teeth observed in children receiving high fluoride intakes. .

with only 55-75% (Ref) of patients responding to fluoride treatment.These factors influence the bioavailability of fluoride from different food sources. or even problematic. bone tissues forming that are not as strong as regular bone.. determining fluoride using fingernail analysis was considered not sensitive enough to detect changes in fluoride ingestion through two seasonally dietary duplicate plate collections and body status assessed through fingernail analysis (Simões de Almeida et al. possibly contributing to an increased prevalence of dental fluorosis – school fluoridation programs. there is a small range between the beneficial effects of fluoride on dental caries reduction and prevalence of dental fluorosis. School-age children have four potential sources of extra fluoride beyond food and water sources.85 mg/day for adults living in cities fluoridating (>0. home dietary fluoride supplements. 2007). Other studies have suggested this treatment as ineffective. 2007. requiring intake ranges to account for this uncertainty in absorption. A recent study of fluoride ingestion from food and dentrific products was conducted with 33 children in a fluoridated community in Brazil (Simões de Almeida. mouth rinse.7 ppm) water. Some studies have reported using fluoride as a therapeutic agent in the treatment of osteoporosis. However. Beverages and water contribute such a high percentage of total fluoride intakes of high . Dietary Intake and Food and Water Sources of Fluoride Recent estimates determine total fluoride intakes to vary depending upon the region. with about 80% coming from the dentrifice (toothpaste) and the remainder coming primarily from water and milk. Most of the children were ingesting more than the recommended amount.3 ppm fluoride in water) intakes have been estimated to be 0.9 mg/day and 1. to arrest bone mineral loss. For young adults in nonfluoridated areas (<0. Additionally. for example. and toothpaste.

2006). Therefore. Conclusion A number of reviews have appeared regarding nutrition and bone health since the DRI on bone related nutrients was released in 1997 (Palacios. . and tea. will contribute significantly to daily fluoride intake. Thus. In addition we are becoming increasingly aware that differences between individual’s genetic make-up impacts the effect of essential and nonessential dietary compounds on health. cereals. This review focused on the research supporting the DRI for some of the bone-health associated essential nutrients along with a discussion of recent related findings. by the time the DRIs for bone-related nutrients are revisited the FNB task will likely be even more difficult than that which the previous panel faced. juices. crab. infant formulas. and vegetables. Additionally. shrimp. foods prepared with fluoridated water at home. will also add significantly to daily fluoride intake. Determining the individual and synergistic activity of and between these essential nutrients and nonessential compounds in maintaining bone health will be a great challenge.availability. Some of this difficulty will likely come from our expanding knowledge of the role nonnutritive compounds play in preventing chronic diseases such as osteoporosis and synergistic actions between essential nutrients and nonessential nutrients such as soy isoflavones. clams. soups. definitions for optimal intakes of specific essential nutrients are becoming increasingly harder to define. lobster. Essential dietary nutrient research has expanded from a prior focus on amounts needed to eliminate deficiency diseases to include the amount required to minimize the onset and impact of chronic diseases. such as marine fish. Foods high in fluoride. it is easy to dismiss the importance of the fluoride content of food. powdered milk. for example. as stated in the previous review in this series.

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adequate intakes. gender and physiological state in the United States and Canada (Food and Nutrition Board. recommended intakes. Dietary Reference Intakes Reference Categories. Figure 1. the highest amount of a nutrient that can be expected to be ingested safely. Dietary intake recommendation categories developed for the purpose of setting estimated average intakes. needed to determine the RDA. ∗ Recommended Dietary Allowance (RDA) – The average daily intake level has not changed in definition from previous years.∗ Estimated Average Requirement (EAR) – is the average daily intake value for a particular nutrient for a given life stage and gender group. ∗ Adequate Intake (AI) – When data are not available to determine a specific EAR. the AI is set as the average amount of a nutrient expected to be sufficient to maintain health. It is the intake level of a specific nutrient that will provide approximately all (97 to 98%) of the persons in a life stage and gender group with sufficient daily quantities to meet body needs. tolerable upper limits for various populations on the basis of age. . ∗ Tolerable Upper Intake Level (UL) – To avoid nutrient toxicities. daily and not cause health risks or adverse reactions to almost all individuals in the general population is known as the UL. It is estimated to satisfy the nutrient intakes of approximately 50% of the persons in that particular life stage and gender group. 1997).

0g 420 350 Women 31-50 y 700 4. phosphorus.0 3. Dietary reference intakes for calcium.0 10.0 3.0 10. vitamin D and fluoride.0 3.0g 410 350 Girls 9-13 y 1250 4.0 10.0g 420 350 Women >70 y 700 3. Standing Committee on the Scientific Evaluation of Dietary Reference Intake.0 10.0 4.0 4.0 4.0g 360 350 Men 19-30 y 700 4.0 3.0g 320 350 *AI=Adequate Intakes established for these life stage groups NE= not possible to establish.0g 310 350 31-50 y 700 4.0 10.S. National Academy Press. Dietary Reference Intakes (DRI) for Magnesium.C.0 10.0g 320 350 Pregnancy 14-18 y 1250 3. magnesium.0g 310 350 Men 31-50 y 700 4.0 3.0 10.0g 360 350 19-30 y 700 4.0 10. Washington.0g 320 350 Men >70 y 700 3.0 3. DRI Life stage Vitamin D µg/day AI UL 5 25 5 25 5 50 5 50 5 50 5 50 5 50 5 50 5 50 5 50 5 50 5 50 10 50 10 50 15 50 15 50 5 50 5 50 5 50 5 50 5 50 5 50 Fluoride mg/day AI UL 0. and Canadian Populations by Life stage and Gender.0 3. UL for Mg = supplementary Mg.3 1.0 3.9 0.0 10.7 1. Vitamin D.2 2.0 10.5g 400 350 19-30 y 700 3.0 3.0g 320 350 Men 51-70 y 700 4.0 10.0 2. .0 10.0g 400 350 Women 19-30 y 700 4. Institute of Medicine.0g 420 350 Women 51-70 y 700 4.0 10.0 10. Fluoride. Adequate Intakes (AI) and Tolerable Upper Levels (UL) for U.0 10.0 3.7 0. Phosphorus Magnesium mg/day mg/day Group *AI/RDA UL *AI/RDA UL Infant 0-6 mo 100* NE 30* NE 7-12 mo 275* NE 75* NE Children 1-3 y 460 3.0 10.5g 350 350 31-50 y 700 3.5 0. D.5g 360 350 Lactation 14-18 y 1250 4.0 10.0 4.0g 80 65 4-8 y 500 3.0 10.Table 1.0 2.0g 240 350 14-18 y 1250 4.0 Food and Nutrition Board.01 0.0 3.0g 130 110 Boys 9-13 y 1250 4.0 3. 1997.0g 240 350 14-18 y 1250 4.

plain. white.Table 2. raw 1 cup 42 NDB_No Description Measure Calcium (mg) 20082 Wheat flour.S. USDA National Nutrient Database for Standard Reference. biscuit. double patty w/ 1 sandwich 284 condiments 10011 Pork. all[purpose. 2006. cooked. Agricultural Research Service. 13 g protein/ 8 oz. cooked. yellow.nal. cooked. . 8 oz. boiled. seedless 1 cup 146 01128 Egg. regular. Nutrient Data Laboratory http://www. 239 09298 Raisins.S. Release 18. self-rising. 1 cup 744 enriched 19062 Snacks. whole. regular. 2007. ham. lean. w/ chocolate chips. hamburger. drained 1 cup 49 09206 Orange juice.pdf49. fried 1 large 96 11724 Beans. access as of Mar 10.usda. cooked. fresh. Department of Agriculture. Halibut. ricotta. trail mix. 1 cup 565 salted nuts and seeds 21005 Fast foods. Pacific. dry heat ½ fillet 453 01037 Cheese. skim milk. Phosphorus Content of Selected Foods Commonly Consumed in the U. with egg and sausage 1 biscuit 490 15037 Fish. part skim milk 1 cup 450 01118 Yogurt. snap. in Common Serving Sizes. Atlantic. 356 21111 Fast foods. roasted 3 oz.

canned. ricotta. boiled. access as of Mar 10. w/o salt Beans. almonds Soy paste.nal.S. Release 18. part skim milk Bananas. Nutrient Data Laboratory http://www.6 fl oz 1 cup 1 cup 1 banana 1 cup Magnesium (mg) 166 134 110 89 78 61 57 48 46 37 32 14 U.S. 24 nuts 1 cup 1 potato 10. raw Measure 1 cup 1 cup 1 cup 1 cup 1 oz. baked. 2006. Agricultural Research Service. Magnesium Content of Selected Foods Commonly Consumed in the U.Table 3. fluid Potato. Department of Agriculture. NDB_No 20080 19062 11546 16025 12061 16120 11674 14210 09298 01037 09040 11206 Description Wheat flour.usda. trail mix. raw Cucumber. . w/o salts Nuts. without salt Coffee. peeled. seedless Cheese. great northern. whole-grain Snacks. mature seeds. 2007. flesh and skin. tropical Tomato products. espresso. USDA National Nutrient Database for Standard Reference. brewed. in Common Serving Sizes. restaurantprepared Raisin.pdf.