Write chapter one summary Can you write chapter one summary? 2The Dental Hygienist’s Guide to Nutritional Care5TH EDITIONCynthia A. Stegeman, RDH,

Write chapter one summary Can you write chapter one summary? 2

The Dental Hygienist’s Guide to
Nutritional Care

5TH EDITION

Cynthia A. Stegeman, RDH,

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Write chapter one summary Can you write chapter one summary? 2

The Dental Hygienist’s Guide to
Nutritional Care

5TH EDITION

Cynthia A. Stegeman, RDH, EdD,
RDN, LD, CDE
Ohio Delegate to the Academy of Nutrition and Dietetics
National Board Dental Hygiene Examination Test Construction Committee
Commission on Dental Competency Assessments Consultant
Professor and Chairperson, Dental Hygiene Program
University of Cincinnati, Blue Ash
Cincinnati, Ohio

Judi Ratliff Davis, MS, RDN
Former Quality Assurance Nutrition Consultant
Women, Infants and Children (WIC) Program
Texas Department of State Health Services
Austin, Texas

3

4

Table of Contents

Cover image

Title Page

Reference Tables

Copyright

Dedication

Preface

New to This Edition

Organization

About Evolve

Note From the Authors

Acknowledgments

About the Authors
Part I Orientation to Basic Nutrition

1 Overview of Healthy Eating Habits

Basic Nutrition

Physiologic Functions of Nutrients

Basic Concepts of Nutrition

Government Nutrition Concerns

5

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Nutrient Recommendations: Dietary Reference Intakes

Food Guidance System for Americans

Support Healthy Eating Patterns for All

MyPlate System

Other Food Guides

Nutrition Labeling

Student Readiness

References

2 Concepts in Biochemistry

What is Biochemistry?

Fundamentals of Biochemistry

Principle Biomolecules in Nutrition

Summary of Metabolism

Student Readiness

References

3 The Alimentary Canal

Physiology of the Gastrointestinal Tract

Oral Cavity

Esophagus

Gastric Digestion

Small Intestine

Large Intestine

Student Readiness

References

4 Carbohydrate

6

Classification

Physiologic Roles

Requirements

Sources

Hyperstates and Hypostates

Nonnutritive Sweeteners/Sugar Substitutes

Student Readiness

References

5 Protein

Amino Acids

Classification

Physiologic Roles

Requirements

Sources

Underconsumption and Health-Related Problems

Overconsumption and Health-Related Problems

Student Readiness

References

6 Lipids

Classification

Chemical Structure

Characteristics of Fatty Acids

Compound Lipids

Cholesterol

Physiologic Roles

7

Dietary Fats and Dental Health

Dietary Requirements

Sources

Overconsumption and Health-Related Problems

Underconsumption and Health-Related Problems

Fat Replacers

Student Readiness

References

7 Use of the Energy Nutrients

Metabolism

Role of the Liver

Role of the Kidneys

Carbohydrate Metabolism

Protein Metabolism

Lipid Metabolism

Alcohol Metabolism

Metabolic Interrelationships

Metabolic Energy

Basal Metabolic Rate

Total Energy Requirements

Energy Balance

Inadequate Energy Intake

Student Readiness

References

8 Vitamins Required for Calcified Structures

8

Overview of Vitamins

Vitamin A (Retinol, Carotene)

Vitamin D (Calciferol)

Vitamin E (Tocopherol)

Vitamin K (Quinone)

Vitamin C (Ascorbic Acid)

Student Readiness

References

9 Minerals Essential for Calcified Structures

Bone Mineralization and Growth

Formation of Teeth

Introduction to Minerals

Calcium

Phosphorus

Magnesium

Fluoride

Student Readiness

References

10 Nutrients Present in Calcified Structures

Copper

Selenium

Chromium

Manganese

Molybdenum

Ultratrace Elements

9

Student Readiness

References

11 Vitamins Required for Oral Soft Tissues and Salivary Glands

Physiology of Soft Tissues

Thiamin (Vitamin B1)

Riboflavin (Vitamin B2)

Niacin (Vitamin B3)

Pantothenic Acid (Vitamin B5)

Vitamin B6 (Pyridoxine)

Folate/Folic Acid (Vitamin B9)

Vitamin B12 (Cobalamin)

Biotin (Vitamin B7)

Other Vitamins

Student Readiness

References

12 Fluids and Minerals Required for Oral Soft Tissues and Salivary
Glands

Fluids

References

Electrolytes

Sodium

Chloride

Potassium

Iron

Zinc

10

Iodine

Student Readiness

References

Part II Application of Nutrition Principles

13 Nutritional Requirements Affecting Oral Health in Women

Healthy Pregnancy

Lactation

Oral Contraceptive Agents

Menopause

Student Readiness

References

14 Nutritional Requirements During Growth and Development and
Eating Habits Affecting Oral Health

Infants

Children Older Than 2 Years of Age: Dietary Guidelines 2015–2020 and Healthy
People 2020

Utilizing the ChooseMyPlate Website

Toddler and Preschool Children

Attention-Deficit/Hyperactivity Disorder

Children With Special Needs

School-Age Children (7–12 Years Old)

Adolescents

Student Readiness

References

15 Nutritional Requirements for Older Adults and Eating Habits
Affecting Oral Health

11

General Health Status

Physiologic Factors Influencing Nutritional Needs and Status

Socioeconomic and Psychological Factors

Nutrient Requirements

Eating Patterns

Dietary Guidelines and MyPlate for Older Adults

Student Readiness

References

16 Food Factors Affecting Health

Health Care Disparities

Food Patterns

Working With Patients With Different Food Patterns

Food Budgets

Maintaining Optimal Nutrition During Food Preparation

Food Fads and Misinformation

Referrals for Nutritional Resources

Role of Dental Hygienists

Student Readiness

References

17 Effects of Systemic Disease on Nutritional Status and Oral Health

Effects of Chronic Disease on Intake

Anemias

Other Hematologic Disorders

Gastrointestinal Problems

Cardiovascular Conditions

12

Skeletal System

Metabolic Problems

Neuromuscular Problems

Neoplasia

Acquired Immunodeficiency Syndrome (AIDS)

Mental Health Problems

Student Readiness

References

Part III Nutritional Aspects of Oral Health

18 Nutritional Aspects of Dental Caries

Major Factors in the Dental Caries Process

Other Factors Influencing Cariogenicity

Dental Hygiene Care Plan

Student Readiness

References

19 Nutritional Aspects of Gingivitis and Periodontal Disease

Physical Effects of Food on Periodontal Health

Nutritional Considerations for Periodontal Patients

Gingivitis

Chronic Periodontitis

Necrotizing Periodontal Diseases

Student Readiness

References

20 Nutritional Aspects of Alterations in the Oral Cavity

13

Orthodontics

Xerostomia

Root Caries and Dentin Hypersensitivity

Dentition Status

Oral and Maxillofacial Surgery

Loss of Alveolar Bone

Glossitis

Temporomandibular Disorder

Student Readiness

References

21 Nutritional Assessment and Education for Dental Patients

Evaluation of the Patient

Assessment of Nutritional Status

Identification of Nutritional Status

Formation of Nutrition Treatment Plan

Facilitative Communication Skills

Student Readiness

References

Glossary

Answers to Nutritional Quotient Questions

Index

IBC

14

15

Reference Tables

Criteria and Dietary Reference Intake Values: For Energy by Active
Individuals by Life Stage Groupa

Life Stage
Group

Criterion
ACTIVE PAL EERb
(kcal/d)
Male Female

0 through 6
mo

Energy expenditure plus energy deposition 570 520 (3 mo)

7 through
12 mo

Energy expenditure plus energy deposition 743 676 (9 mo)

1 through 2
y

Energy expenditure plus energy deposition 1,046 992 (24 mo)

3 through 8
y

Energy expenditure plus energy deposition 1,742 1,642 (6 y)

9 through
13 y

Energy expenditure plus energy deposition 2,279 2,071 (11 y)

14 through
18 y

Energy expenditure plus energy deposition 3,152 2,368 (16 y)

>18 y Energy expenditure 3,067c 2,403c (19 y)
Pregnancy
14 through
18 y

Adolescent female EER plus change in Total Energy Expenditure (TEE) plus
pregnancy energy deposition

1st
trimester

2,368 (16 y)

2nd
trimester

2,708 (16 y)

3rd
trimester

2,820 (16 y)

19 through
50 y

Adult female EER plus change in TEE plus pregnancy energy deposition

1st
trimester

2,403c (19 y)

2nd
trimester

2,743c (19 y)

3rd
trimester

2,855c (19 y)

Lactation
14 through
18 y

Adolescent female EER plus milk energy output minus w eight loss

1st 6 mo 2,698 (16 y)
2nd 6 mo 2,768 (16 y)
19 through
50 y

Adult female EER plus milk energy output minus w eight loss

1st 6 mo 2,733c (19 y)
2nd 6 mo 2,803c (19 y)

aFor healthy active Americans and Canadians. Based on the cited age, an active physical
activity level, and the reference heights and weights cited in Table 1.1. Individualized EERs
can be determined by using the equations in Chapter 5.
bPAL = Physical Activity Level, EER = Estimated Energy Requirement. The intake that
meets the average energy expenditure of individuals at the reference height, weight, and

16

age (see Table 1.1).
cSubtract 10 kcal/d for males and 7 kcal/d for females for each year of age above 19
years.

Reproduced with permission from Energy Calculations for Active Individuals by Life Stage
Group. In Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and
Sulfate, National Academy of Sciences. Washington, DC: National Academies Press,
2005.

Dietary Reference Intakes (DRIs): Dietary Allowances and Adequate
Intakes, Total Water, and Macronutrients (Food and Nutrition Board,
National Academy of Medicine)

Life
Stage
Group

Total
Water
(L/d)

PROTEIN CARBOHYDRATE FIBER FAT
n-6
POLYUNSATURATED
FATTY ACIDS (α-
linoleic acid)

n
POLYUNSATURATED
FATTY ACIDS (α-
linoleic acid)

RDA/AI
g/daya

AMDRb
RDA/AI
g/day AMDR

b RDA/AI
g/day AMDR

b RDA/AI
g/day AMDR

b RDA/AI
g/day AMDR

b

Infants
0–6
mo

0.7* 9.1 NDc 60 ND ND ND 31 4.4* ND

7–12
mo

0.8* 11.0 ND 95 ND ND ND 30 4.6* ND

Children
1–3 y 1.3* 13 5–20 130 45–65 19* ND ND 30–40 7* 5–10
4–8 y 1.7* 19 10–30 130 45–65 25* ND ND 25–35 10* 5–10
Males
9–13 y 2.4* 34 10–30 130 45–65 31* ND ND 25–35 12* 5–10
14–18
y

3.3* 52 10–30 130 45–65 38* ND ND 25–35 16* 5–10

19–30
y

3.7* 56 10–35 130 45–65 38* ND ND 20–35 17* 5–10

31–50
y

3.7* 56 10–35 130 45–65 38* ND ND 20–35 17* 5–10

51–70
y

3.7* 56 10–35 130 45–65 30* ND ND 20–35 14* 5–10

>70 y 3.7* 56 10–35 130 45–65 30* ND ND 20–35 14* 5–10
Females
9–13 y 2.1* 34 10–30 130 45–65 26* ND ND 25–35 10* 5–10
14–18
y

2.3* 46 10–30 130 45–65 26* ND ND 25–35 11* 5–10

19–30
y

3.7* 46 10–35 130 45–65 25* ND ND 20–35 12* 5–10

31–50
y

3.7* 46 10–35 130 45–65 25* ND ND 20–35 12* 5–10

51–70
y

3.7* 46 10–35 130 45–65 21* ND ND 20–35 11* 5–10

>70 y 3.7* 46 10–35 130 45–65 21* ND ND 20–35 11* 5–10
Pregnant
≤18 y 3.0* 71 10–35 175 45–65 28* ND ND 20–35 13* 5–10
19–30
y

3.0* 71 10–35 175 45–65 28* ND ND 20–35 13* 5–10

31–50
y

3.0* 71 10–35 175 45–65 28* ND ND 20–35 13* 5–10

Lactating
≤18 y 3.8* 71 10–35 210 45–65 29* ND ND 20–35 13* 5–10

17

19–30
y

3.8* 71 10–35 210 45–65 29* ND ND 20–35 13* 5–10

31–50
y

3.8* 71 10–35 210 45–65 29* ND ND 20–35 13* 5–10

aBased on 1.5 g/kg/day for infants, 1.1 g/kg/day for 1–3 y; 0.95 g/kg/day for 4–13 y, 0.85
g/kg/day for 14–18 y, 0.8 g/kg/day for adults, and 1.1 g/kg/day for pregnant (using
prepregnancy weight) and lactating women.
bAcceptable Macronutrient Distribution Range (AMDR) is the range of intake for a
particular energy source that is associated with reduced risk of chronic disease while
providing intakes of essential nutrients. If an individual has consumed in excess of the
AMDR, there is a potential of increasing the risk of chronic diseases and insufficient
intakes of essential nutrients.
cND 5 Not determinable due to lack of data of adverse effects in this age group and
concern with regard to lack of ability to handle excess amounts. Source of intake should
be from food only to prevent high levels of intake.
dApproximately 10% of the total can come from longer-chain, n-3 fatty acids.

Dietary cholesterol, trans fatty acids, saturated fatty acids: As low as possible while
consuming a nutritionally adequate diet.

Added sugars: Limit to no more than 25% of total energy.e

Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids,
Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press,
2002.

Note: This table represents Recommended Dietary Allowances (RDAs) in bold type and
*Adequate Intakes (AIs) in ordinary type. RDAs and AIs may both be used as goals for
individual intake. RDAs are set to meet the needs of almost all (97%–98%) individuals in a
group. For healthy breastfed infants, the AI is the mean intake. The AI for other life-stage
and gender groups is believed to cover the needs of all individuals in the group, but lack of
data prevents being able to specify with confidence the percentage of individuals covered
by this intake.

Dietary Reference Intakes (DRIs): Recommended Dietary Allowances
and Adequate Intakes, Vitamins (Food and Nutrition Board, National
Academy of Medicine)

Life
Stage
Group

Vitamin
A
(µg/d)a

Vitamin
C
(mg/d)

Vitamin
D
(µg/d)b,c

Vitamin
E
(mg/d)d

Vitamin
K
(µg/d)

Thiamin
(mg/d)

Riboflavin
(mg/d)

Niacin
(mg/d)e

Vitamin
B6
(mg/d)

Folate
(µg/d)f

Vitamin
B12
(µg/d)

Pantothenic
Acid (mg/d)

Infants
0–6
mo

400* 40* 13 4* 2.0* 0.2* 0.3* 2* 0.1* 65* 0.4* 1.7*

7–12
mo

500* 50* 15 5* 2.5* 0.3* 0.4* 4* 0.3* 80* 0.5* 1.8*

Children
1–3 y 300 15 15 6 30* 0.5 0.5 6 0.5 150 0.9 2*
4–8 y 400 25 15 7 55* 0.6 0.6 8 0.6 200 1.2 3*
Males
9–13 y 600 45 15 11 60* 0.9 0.9 12 1.0 300 1.8 4*
14–18 900 75 15 15 75* 1.2 1.3 16 1.3 400 2.4 5*

18

y
19–30
y

900 90 15 15 120* 1.2 1.3 16 1.3 400 2.4 5*

31–50
y

900 90 15 15 120* 1.2 1.3 16 1.3 400 2.4 5*

51–70
y

900 90 15 15 120* 1.2 1.3 16 1.7 400 2.4h 5*

>70 y 900 90 20 15 120* 1.2 1.3 16 1.7 400 2.4h 5*
Females
9–13 y 600 45 15 11 60* 0.9 0.9 12 1.0 300 1.8 4*
14–18
y

700 65 15 15 75* 1.0 1.0 14 1.2 400i 2.4 5*

19–30
y

700 75 15 15 90* 1.1 1.1 14 1.3 400i 2.4 5*

31–50
y

700 75 15 15 90* 1.1 1.1 14 1.3 400i 2.4 5*

51–70
y

700 75 15 15 90* 1.1 1.1 14 1.5 400 2.4h 5*

>70 y 700 75 20 15 90* 1.1 1.1 14 1.5 400 2.4h 5*
Pregnancy
14–18
y

750 80 15 15 75* 1.4 1.4 18 1.9 600j 2.6 6*

19–30
y

770 85 15 15 90* 1.4 1.4 18 1.9 600j 2.6 6*

31–50
y

770 85 15 15 90* 1.4 1.4 18 1.9 600j 2.6 6*

Lactation
14–18
y

1,200 115 15 19 75* 1.4 1.6 17 2.0 500 2.8 7*

19–30
y

1,300 120 15 19 90* 1.4 1.6 17 2.0 500 2.8 7*

31–50
y

1,300 120 15 19 90* 1.4 1.6 17 2.0 500 2.8 7*

aAs retinol activity equivalents (RAEs). 1 RAE = 1 µg retinol, 12 µg β-carotene, 24 µg β-
carotene, or 24 µg β-cryptoxanthin. The RAE for dietary provitamin A carotenoids is
twofold greater than retinol equivalents (RE), whereas the RAE for preformed vitamin A is
the same as RE.
bAs cholecalciferol. 1 µg cholecalciferol = 40 IU vitamin D.
cUnder the assumption of minimal sunlight.
dAs α-tocopherol. α-Tocopherol includes RRR-α-tocopherol, the only form of α-tocopherol
that occurs naturally in foods, and the 2R-stereoisomeric forms of α-tocopherol (RRR-,
RSR-, RRS-, and RSS-α-tocopherol) that occur in fortified foods and supplements. It does
not include the 2S-stereoisomeric forms of α-tocopherol (SRR-, SSR-, SRS-, and SSS-α-
tocopherol), also found in fortified foods and supplements.
eAs niacin equivalents (NE). 1 mg of niacin = 60 mg of tryptophan; 0–6 months =
preformed niacin (not NE).
fAs dietary folate equivalents (DFE). 1 DFE = 1 µg food folate = 0.6 µg of folic acid from
fortified food or as a supplement consumed with food = 0.5 µg of a supplement taken on
an empty stomach.
gAlthough AIs have been set for choline, there are few data to assess whether a dietary
supply of choline is needed at all stages of the life cycle, and it may be that the choline
requirement can be met by endogenous synthesis at some of these stages.

19

hBecause 10% to 30% of older people may malabsorb food-bound B12, it is advisable for
those older than 50 years to meet their RDA mainly by consuming foods fortified with B12
or a supplement containing B12.
iIn view of evidence linking folate intake with neural tube defects in the fetus, it is
recommended that all women capable of becoming pregnant consume 400 µg from
supplements or fortified foods in addition to intake of food folate from a varied diet.
jIt is assumed that women will continue consuming 400 µg from supplements or fortified
food until their pregnancy is confirmed and they enter prenatal care, which ordinarily
occurs after the end of the periconceptional period—the critical time for formation of the
neural tube.
NOTE: This table (taken from the DRI reports; see www.nap.edu) presents Recommended
Dietary Allowances (RDAs) in bold type and Adequate Intakes (AIs) in ordinary type
followed by an asterisk (*). An RDA is the average daily dietary intake level; sufficient to
meet the nutrient requirements of nearly all (97%–98%) healthy individuals in a group. It is
calculated from an Estimated Average Requirement (EAR). If sufficient scientific evidence
is not available to establish an EAR for calculating an RDA, an AI is usually developed. For
healthy breastfed infants, an AI is the mean intake. The AI for other life-stage and gender
groups is believed to cover the needs of all healthy individuals in the groups, but lack of
data or uncertainty in the data prevent being able to specify with confidence the
percentage of individuals covered by this intake.

SOURCES: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D,
and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin
B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference
Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference
Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron,
Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); Dietary
Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005); and
Dietary Reference Intakes for Calcium and Vitamin D (2011). These reports may be
accessed via www.nap.edu.

20

http://www.nap.edu

http://www.nap.edu

Dietary Reference Intakes (DRIs): Recommended Dietary Allowances
and Adequate Intakes, Elements (Food and Nutrition Board, National
Academy of Medicine)

Life-Stage
Group

Calcium
(mg/d)

Chromium
(µg/d)

Copper
(µg/d)

Fluoride
(mg/d)

Iodine
(µg/d)

Iron
(mg/d)

Magnesium
(mg/d)

Infants
0–6 mo 200* 0.2* 200* 0.01* 110* 0.27* 30*
7–12 mo 260* 5.5* 220* 0.5* 130* 11 75*
Children
1–3 y 700* 11* 340 0.7* 90 7 80
4–8 y 1000* 15* 440 1* 90 10 130
Males
9–13 y 1,300* 25* 700 2* 120 8 240
14–18 y 1,300* 35* 890 3* 150 11 410
19–30 y 1,000* 35* 900 4* 150 8 400
31–50 y 1,000* 35* 900 4* 150 8 420
51–70 y 1,200* 30* 900 4* 150 8 420
>70 y 1,200* 30* 900 4* 150 8 420
Females
9–13 y 1,300* 21* 700 2* 120 8 240
14–18 y 1,300* 24* 890 3* 150 15 360
19–30 y 1,000* 25* 900 3* 150 18 310
31–50 y 1,000* 25* 900 3* 150 18 320
51–70 y 1,200* 20* 900 3* 150 8 320
>70 y 1,200* 20* 900 3* 150 8 320
Pregnancy
≤18 y 1,300* 29* 1,000 3* 220 27 400
19–30 y 1,000* 30* 1,000 3* 220 27 350
31–50 y 1,000* 30* 1,000 3* 220 27 360
Lactation
≤18 y 1,300* 11* 1,300 3* 290 10 360
19–30 y 1,000* 15* 1,300 3* 290 9 310
31–50 y 1,000* 45* 1,300 3* 290 9 320

Copyright 2001 by the National Academy of Sciences. All rights reserved.

SOURCES: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D,
and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin
B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference
Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference
Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron,
Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); Dietary
Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2005); and
Dietary Reference Intakes for Calcium and Vitamin D (2011). These reports may be
accessed via www.nap.edu.

Dietary Reference Intakes (DRIs): Estimated Average Requirements
(Food and Nutrition Board, National Academy of Medicine)

Life
Stage-
Group

Calcium
(mg/d)

CHO
(g/kg/d)

Protein
(g/d)

Vitamin
A
(µg/d)a

Vitamin
C
(mg/d)

Vitamin
D
(µg/d)

Vitamin
E
(mg/d)b

Thiamin
(mg/d)

Riboflavin
(mg/d)

Niacin
(mg/d)c

Vitamin
B6
(mg/d)

Infants
0–6

21

http://www.nap.edu

mo
7–12
mo

1.0

Children
1–3 y 500 100 0.87 210 13 10 5 0.4 0.4 5 0.4
4–8 y 800 100 0.76 275 22 10 6 0.5 0.5 6 0.5
Males
9–13 y 1,100 100 0.76 445 39 10 9 0.7 0.8 9 0.8
14–18
y

1,100 100 0.73 630 63 10 12 1.0 1.1 12 1.1

19–30
y

800 100 0.66 625 75 10 12 1.0 1.1 12 1.1

31–50
y

800 100 0.66 625 75 10 12 1.0 1.1 12 1.1

51–70
y

800 100 0.66 625 75 10 12 1.0 1.1 12 1.4

>70 y 1,000 100 0.66 625 75 10 12 1.0 1.1 12 1.4
Females
9–13 y 1,100 100 0.76 420 39 10 9 0.7 0.8 9 0.8
14–18
y

1,100 100 0.71 485 56 10 12 0.9 0.9 11 1.0

19–30
y

800 100 0.66 500 60 10 12 0.9 0.9 11 1.1

31–50
y

800 100 0.66 500 60 10 12 0.9 0.9 11 1.1

51–70
y

1,000 100 0.66 500 60 10 12 0.9 0.9 11 1.3

>70 y 1,000 100 0.66 500 60 10 12 0.9 0.9 11 1.3
Pregnancy
14–18
y

1,000 135 0.88 530 66 10 12 1.2 1.2 14 1.6

19–30
y

800 135 0.88 550 70 10 12 1.2 1.2 14 1.6

31–50
y

800 135 0.88 550 70 10 12 1.2 1.2 14 1.6

Lactation
14–18
y

1,000 160 1.05 885 96 10 16 1.2 1.3 13 1.7

19–30
y

800 160 1.05 900 100 10 16 1.2 1.3 13 1.7

31–50
y

800 160 1.05 900 100 10 16 1.2 1.3 13 1.7

aAs retinol activity equivalents (RAEs). 1 RAE = 1 µg retinol, 12 µg β-carotene, 24 µg α-
carotene, or 24 µg β-cryptoxanthin. The RAE for dietary provitamin A carotenoids is two-
fold greater than retinol equivalents (RE), whereas the RAE for preformed vitamin A is the
same as RE.
bAs α-tocopherol. α-Tocopherol includes RRR-α-tocopherol, the only form of α-tocopherol
that occurs naturally in foods, and the 2R-stereoisomeric forms of α-tocopherol (RRR-,
RSR-, RRS-, and RSS-α-tocopherol) that occur in fortified foods and supplements. It does
not include the 2S-stereoisomeric forms of α-tocopherol (SRR-, SSR-, SRS-, and SSS-α-
tocopherol), also found in fortified foods and supplements.
cAs niacin equivalents (NE). 1 mg of niacin = 60 mg of tryptophan.
dAs dietary folate equivalents (DFE). 1 DFE = 1 µg food folate = 0.6 µg of folic acid from
fortified food or as a supplement consumed with food = 0.5 µg of a supplement taken on
an empty stomach.

22

Note: An Estimated Average Requirement (EAR) is the average daily nutrient intake level
estimated to meet the requirements of the healthv individuals in a group. EARs have not
been established for vitamin K, pantothenic acid, biotin, choline, chromium, fluoride,
manganese, or other nutrients not yet evaluated via the DRI process.

SOURCES: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D,
and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin
B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference
Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference
Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron,
Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); Dietary
Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol,
Protein, and Amino Acids (2002/2005); and Dietary Reference Intakes for Calcium and
Vitamin D (2011). These reports may be accessed via www.nap.edu.

Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels,
Vitamins (Food and Nutrition Board, National Academy of Medicine)

Life-
Stage
Group

Vitamin
A
(µg/d)a

Vitamin
C
(mg/d)

Vitamin
D
(µg/d)

Vitamin
E
(mg/d)b,c

Vitamin
K

Thiamin Riboflavin
Niacin
(mg/d)c

Vitamin
B6
(mg/d)

Folate
(µg/d)c

Vitamin
B12

Infants
0–6
mo

600 NDe 25 ND ND ND ND ND ND ND ND

7–12
mo

600 ND 38 ND ND ND ND ND ND ND ND

Children
1–3 y 600 400 63 200 ND ND ND 10 30 300 ND
4–8 y 900 650 75 300 ND ND ND 15 40 400 ND
Males
9–13 y 1,700 1,200 100 600 ND ND ND 20 60 600 ND
14–18
y

2,800 1,800 100 800 ND ND ND 30 80 800 ND

19–30
y

3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

31–50
y

3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

51–70
y

3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

>70 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND
Females
9–13 y 1,700 1,200 100 600 ND ND ND 20 60 600 ND
14–18
y

2,800 1,800 100 800 ND ND ND 30 80 800 ND

19–30
y

3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

31–50
y

3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

51–70
y

3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

>70 y 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND
Pregnancy
14–18
y

2,800 1,800 100 800 ND ND ND 30 80 800 ND

19–30
y

3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

31–50 3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

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y
Lactation
14–18
y

2,800 1,800 100 800 ND ND ND 30 80 800 ND

19–30
y

3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

31–50
y

3,000 2,000 100 1,000 ND ND ND 35 100 1,000 ND

aAs preformed vitamin A only.
bAs α–tocopherol; applies to any form of supplemental α–tocopherol.
cThe ULs for vitamin E, niacin, and folate apply to synthetic forms obtained from
supplements, fortified foods, or a combination of the two.
dβ-Carotene supplements are advised only to serve as a provitamin A source for
individuals at risk of vitamin A deficiency.
eND = Not determinable due to lack of data of adverse effects in this age group and
concern with regard to lack of ability to handle excess amounts. Source of intake should
be from food only to prevent high levels of intake.

Note: A Tolerable Upper Intake Level (UL) is the highest level of daily nutrient intake that is
likely to pose no risk of adverse health effects to almost all individuals in the general
population. Unless otherwise specified, the UL represents total intake from food, water, and
supplements. Due to a lack of suitable data, ULs could not be established for vitamin K,
thiamin, riboflavin, vitamin B12, pantothenic acid, biotin, and carotenoids. In the absence of
a UL, extra caution may be warranted in consuming levels above recommended intakes.
Members of the general population should be advised not to routinely exceed the UL. The
UL is not meant to apply to individuals who are treated with the nutrient under medical
supervision or to individuals with predisposing conditions that modify their sensitivity to the
nutrient.

SOURCES: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D,
and Fluoride (1997); Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin
B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline (1998); Dietary Reference
Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000); Dietary Reference
Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron,
Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001); and Dietary
Reference Intakes for Calcium and Vitamin D (2011). These reports may be accessed via
www.nap.edu.

Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels,
Elements (Food and Nutrition Board, National Academy of Medicine)

Life-
Stage
Group

Arsenica
Boron
(mg/d)

Calcium
(mg/d) Chromium

Copper
(µg/d)

Fluoride
(mg/d)

Iodine
(µg/d)

Iron
(mg/d)

Magnesium
(mg/d)b

Manganese
(mg/d)

Molybdenum
(µg/d)

Infants
0–6
mo

NDe ND 1,000 ND ND 0.7 ND 40 ND ND ND

7–12
mo

ND ND 1,500 ND ND 0.9 ND 40 ND ND ND

Children

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1–3 y ND 3 2,500 ND 1,000 1.3 200 40 65 2 300
4–8 y ND 6 2,500 ND 3,000 2.2 300 40 110 3 600
Males
9–13 y ND 11 3,000 ND 5,000 10 600 40 350 6 1,100
14–18
y

ND 17 3,000 ND 8,000 10 900 45 350 9 1,700

19–30
y

ND 20 2,500 ND 10,000 10 1,100 45 350 11 2,000

31–50
y

ND 20 2,500 ND 10,000 10 1,100 45 350 11 2,000

51–70
y

ND 20 2,000 ND 10,000 10 1,100 45 350 11 2,000

>70 y ND 20 2,000 ND 10,000 10 1,100 45 350 11 2,000
Females
9–13 y ND 11 3,000 ND 5,000 10 600 40 350 6 1,100
14–18
y

ND 17 3,000 ND 8,000 10 900 45 350 9 1,700

19–30
y

ND 20 2,500 ND 10,000 10 1,100 45 350 11 2,000

31–50
y

ND 20 2,500 ND 10,000 10 1,100 45 350 11 2,000

51–70
y

ND 20 2,000 ND 10,000 10 1,100 45 350 11 2,000

>70 y ND 20 2,000 ND 10,000 10 1,100 45 350 11 2,000
Pregnancy
14–18
y

ND 17 3,000 ND 8,000 10 900 45 350 9 1,700

19–30
y

ND 20 2,500 ND 10,000 10 1,100 45 350 11 2,000

31–50
y

ND 20 2,500 ND 10,000 10 1,100 45 350 11 2,000

Lactation
14–18
y

ND 17 3,000 ND 8,000 10 900 45 350 9 1,700

19–30
y

ND 20 2,500 ND 10,000 10 1,100 45 350 11 2,000

31–50
y

ND 20 2,500 ND 10,000 10 1,100 45 350 11 2,000

aAlthough the UL was not determined for arsenic, there is no justification for adding
arsenic …


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