what-when-how
In Depth Tutorials and Information
Carbohydrate
Carbohydrate (sugars and starches) is primarily
used by the body as an energy source, especially for the
brain, which is carbohydrate dependent. The IOM sets
the RDA for carbohydrate at 130 grams/day; however,
when protein and fat meet the AMDR, the intake of car-
bohydrate will typically be higher in order to meet total
energy needs.
3
The AMDR for carbohydrate in healthy adults is
45-65% of kcalories.
3
For an otherwise healthy adult
with OI, the AMDR should provide an acceptable
amount of carbohydrate. If co-morbidities of carbohy-
drate metabolism such as diabetes are present, guidelines
specific to those disease states would be recommended.
The Dietary Guidelines for Americans 2010
(Chapter 4)
12
recommends consuming half of all grains
in the form of whole grains, which are sources of
dietary fiber, minerals including iron and magnesium,
and B vitamins. Moderate evidence suggests that intake
of whole grains may decrease the risk of CVD, obesity
and type 2 diabetes.
and vitamins A and C. Fluoride is important to assist
in maintaining the integrity of teeth and bone. Some
studies suggest that serum concentrations of calcium,
vitamin D and phosphorus are typically normal or
comparable to values found in persons without OI;
14
therefore, as a starting point, persons with OI are rec-
ommended to strive to meet the DRIs for micronutri-
ents by eating a balanced, varied diet. If more specific
guidance is needed, consultation with an RD may be
helpful.
Calcium and Bone Health
Calcium does not repair the collagen defects that
cause OI; however, persons with OI should be sure to
take in adequate calcium to maximize their bone mass
and prevent bone loss.
15
Ingesting excessive amounts
of calcium through diet plus supplements is not
recommended.
As a starting point, persons with OI are rec-
ommended to meet the DRI for calcium.
Recommendations are based on age and stage of bone
development, with the highest recommended intake
during the years of peak bone development. Especially
for persons with OI, adequate intake (AI) of calcium is
important throughout the life cycle (
Table 40.1
).
In their 2010 summary of current and emerging treat-
ments for the management of OI, Monti et al. recom-
mend 800-1000 mg of calcium per day during infancy.
16
The American Academy of Pediatrics (AAP), however,
notes that retention of dietary calcium is low in younger
children and gradually increases as the individual
approaches puberty.
17
AAP finds no evidence to sug-
gest that exceeding the amount of calcium retained by a
breastfed infant promotes higher retention of calcium or
results in long-term increase in bone mineralization.
17
Human milk averages 200-340 mg/liter.
18,19
The DRI is
set at 200-270 mg/day.
Dairy foods are an excellent source of dietary cal-
cium. A serving typically meets about 30% of the AI
Fiber
Dietary fiber is a non-digestible form of carbohy-
drate. Soluble fiber helps reduce serum cholesterol,
slow glucose absorption, slow gastrointestinal tran-
sit time, which promotes satiety, and hold moisture in
feces, helping to prevent constipation. Insoluble fiber
increases fecal weight and speeds fecal passage through
the colon. Sources of insoluble fiber include grains,
fruits, vegetables, legumes, nuts and seeds. Individuals
with OI may be prone to constipation;
13
therefore
sources of both soluble and insoluble fiber should be
included in the diet.
There are no studies that look specifically at whether
persons with OI have significantly different require-
ments for individual macronutrients or whether oth-
erwise healthy individuals with OI would require a
different proportion of macronutrients. It seems pru-
dent, therefore, for healthy individuals with OI to fol-
low the AMDRs set out by the IOM.
TABLE 40.1
Adequate Intake for Calcium
Adequate Intake for
Calcium, mg/day
Population Group
M
ICRONUTRIENTS AND O
I
Children age 0-6 months
210
Although the collagen defects that cause OI are
not resolved by dietary intervention, adequate intake
of micronutrients, especially those involved in bone
health, is important to promote and maintain optimal
bone health. The micronutrients most commonly asso-
ciated with bone formation and maintenance are cal-
cium and vitamin D. Other micronutrients that play
a role in healthy bone are magnesium, phosphorus,
Children age 7-12 months
270
Children ages 1-3 years
500
Children ages 4-8 years
800
Preteens/adolescents ages 9-18 years
1300
Adults ages 19-50 years
1000
Adults 51 years and older
1200
