Calcium and vitamin D

Calcium:

• Children 1-5: 800 mg
• Children 6-10: 1200 mg
• Children 11-24: 1200-1500 mg

Vitamin D:

• Infants: 400 IU
• Children: 400 IU
• Adolescents and adults: 400 IU

These recommendations assume there is no dietary intake of calcium and vitamin D, and that there is no exposure to sunlight (vitamin D only), and are meant as guidelines only. An excellent review of current knowledge regarding vitamin D deficiency can be found in [Misra: 2008].

In general, the American Academy of Pediatrics and American Dietetic Association recommend that nutrients for healthy children should be consumed from foods. For nutritionally vulnerable populations, multivitamin-mineral supplements can help meet nutrition needs.
Calcium: Children eating a regular diet tend to get about 200 mg of calcium at baseline, and about 300 mg for each serving of dairy products, such as milk, yogurt, and cheese. Calcium-fortified orange juice contains about the same amount of calcium as an equivalent amount of milk. A few vegetables, including broccoli, rhubarb, soybeans, arugula, kale and collard greens contain smaller amounts of calcium. High calcium intake above 1,200-1,500 is not necessary. Timing of calcium supplements by taking between meals can minimize calcium-induced inhibition of iron absorption.
Vitamin D: Although our bodies can make vitamin D after skin is exposed to sunlight, most people now limit sun exposure. Vitamin D is naturally present in very few foods; it is added to many and is also available as a dietary supplement. The most common natural and fortified sources of vitamin D include: some fatty fish such as tuna and salmon; most milk; and many types of orange juice, yogurt, cheeses, breakfast cereals, breads and soy drinks. Most milk is fortified with 100 IU of vitamin D in an 8-ounce serving.

In general the American Academy of Pediatrics and American Dietetic Association recommend that nutrients for healthy children should be consumed from foods. For nutritionally vulnerable populations, multivitamin-mineral supplements can help meet nutrition needs. The safest and most economical way to ensure adequate vitamin D status is to use oral dosing of native vitamin D. (Both daily and intermittent regimens work well. [Russo: 2011]) Serum 25(OH)D can be expected to rise by about 1 ng/mL (2.5 nmol/L) for every 100 IU of additional vitamin D each day. [Heaney: 2008]
Cathy Breedon PhD, RD, CSP, FADA outlines a plan to address Vitamin D as follows:

• To avoid excess supplementation or suboptimal intake of Vitamin D, it is recommended to test levels of 25-hydroxy D regularly (for everyone). Testing the level during the winter is most likely to pick up any inadequacy issues. A level drawn any time of year will help identify problems for people who are not regularly in the sun even in the summer. This includes a large number of people, for a variety of reasons. If it is low give a therapeutic supplemental amount of vitamin D to return to normal and then figure out a maintenance dose once tests show that the low level has been corrected. It is wise not to assume it has been corrected after some prescribed number of doses.
• If the person has good blood levels of 25-hydroxyD but still looks “suspicious” in terms of vitamin D-related conditions, then get a 1,25 D level to see if they have a metabolic defect in hydroxylation in the kidney or some other condition like kidney disease that is impairing production of the hormonal form. In that situation, one would utilize a special prescription form of supplemental vitamin D to get around the problem: the ready-to-go form of the active hormone 1,25-dihydroxyD which is usually ordered as calcitriol. [Breedon 2008]

Cathy Breedon PhD, RD, CSP, FADA Prenatal/Pediatric Nutrition Specialist, Clinical Nutrition Specialist MeritCare Medical Center, Fargo, ND, and UND School of Medicine “Aunt Cathy’s Guide:Vitamin D: A Quick Review of Forms, Labs and Other Things People Have Asked Me About Recently” Aunt Cathy's Guide: Vitamin D: A Quick Review of Forms, Labs, and Other Things People Have Asked Me About Recently ( 56 KB)