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Int. J. Environ. Res. Public Health 2009, 6(10), 2585-2607; doi:10.3390/ijerph6102585
Abstract: Vitamin D and calcium insufficiencies are risk factors for multiple chronic diseases. Data from 46 recent studies from Europe, North America, South-East Asia and the South Pacific area clearly indicate that a low vitamin D status and inadequate calcium nutrition are highly prevalent in the general population (30–80%), affecting both genders. The extent of insufficiencies is particularly high in older populations, and in some geographical areas, also in children and in young women of child-bearing age, in ethnic minorities and immigrants, as well as in people of low socio-economic status. Enrichment of cereal grain products with vitamin D and calcium would be a viable approach to increase consumption and improve health outcomes in the general population worldwide.
1. Introduction
It is common knowledge that an inadequate supply of vitamin D and calcium has negative effects on bone health at all ages, inasmuch as it causes rickets in infants, retards acquisition of an adequate bone mass during skeletal development in adolescents, and is finally responsible for accelerated bone loss in adulthood in both women and men, leading to the development of osteoporosis. Importantly, there is also evidence from epidemiological studies, clinical intervention trials as well as from studies with animal models of human diseases that a compromised vitamin D status and inadequate calcium nutrition are predisposing conditions for a great number of other diseases, including various types of cancer, chronic infectious, inflammatory and autoimmune diseases, metabolic disorders, as well as hypertension and cardiovascular diseases (Table 1; for details, [1–3]).
2. Why a Low Vitamin D Status and a Nutritional Calcium Deficit are Risk Factors for many Chronic Diseases
Vitamin D comes from two sources in humans, it could either be synthesized in form of vitamin D3 (cholecalciferol) under the influence of solar UV-B radiation in the epidermis, or be absorbed from the diet or from supplements and food additives, which in some countries may contain vitamin D2 (ergocalciferol). In any form, vitamin D is transferred to the liver, where it is metabolized to 25-hydroxyvitamin D (25-(OH)D). The term 25-(OH)D is used to denote the sum of 25-(OH)D3 and 25-(OH)D2. Thus, the plasma level of this metabolite reflects the sum of vitamin D from endogenous synthesis and from dietary intake, and is therefore a reliable indicator of an individual's vitamin D status.
Conversion of 25-(OH)D3 to the biologically most active metabolite, 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3), is catalyzed by the CYP27B1-encoded enzyme, 25-(OH)D-1α-hydroxylase, and takes place predominantly in the kidney, but also at many extra-renal sites [4] (see Figure 1): Examples are normal and neoplastic epithelial cells of the skin [5], of the gastrointestinal tract [6,7] and of female and male reproductive organs [8–10] as well as osteoblasts and osteoclasts [11,12] and cells of the vascular [13], the central nervous [14] and the immune system [15,16].
1,25-(OH)2D3 bound to the nuclear high-affinity vitamin D receptor (VDR) functions as a transactivating regulator of gene expression. Circulating 1,25-(OH)2D3, which is produced by up to 90% in the kidney, plays a key role in systemic calcium and phosphate homeostasis by regulating ion fluxes in its classical target organs, i.e., small intestine, kidney and bone. 1,25-(OH)2D3 is also an important local regulator of cellular proliferation, differentiation and function in many organs and cell systems that express the 25-(OH)D-1α-hydroxylase [4] (Figure 1). The extent of intracellular synthesis of 1,25-(OH)2D3 at extra-renal sites depends largely on ambient 25-(OH)D3 levels and is not associated with circulating 1,25-(OH)2D3 concentrations (e.g., [17]). Therefore, at low serum levels of 25-(OH)D, 25-(OH)D-1α-hydroxylase activity may not be sufficient to maintain tissue concentrations of 1,25-(OH)2D3 necessary for efficient autocrine/paracrine regulation of cellular growth and function. This explains why many chronic diseases, as listed in Table 1, show significant negative associations with serum 25-(OH)D [1,3,18]. Importantly, low serum 25-(OH)D has been shown to be a reliable predictor of all-cause mortality [19].
There is evidence from many human and animal studies for a significant inverse relationship between dietary calcium and risk of multiple chronic diseases [1]. This is difficult to understand because the effect of even large variations in calcium intake levels on extracellular calcium concentrations [Ca2+]o is attenuated by the systemic actions of calcium-regulating hormones allowing physiological variations in [Ca2+]o to occur only within a narrow range. However, many types of cells express a calcium-sensing receptor (CaR), which senses even minute changes in [Ca2+]o and thus allows Ca2+ to function as a "first messenger" for various cellular responses [20]. An important feature of the CaR is the high cooperativity between multiple Ca2+-binding sites in its extracellular domain. This results in amplification of signals from extracellular Ca2+, which, by cell-specific coupling to stimulatory and inhibitory G proteins, are transduced into various intracellular signalling pathways. Expression of a functioning CaR thus allows cell-specific reactions to physiological changes in [Ca2+]o. The CaR not only controls PTH secretion from parathyroid gland cells but plays key roles in normal cartilage and bone formation [21–23], as well as in limitation of cellular growth of normal and neoplastic cells [2,24]. Conversely, low dietary calcium causes hyperparathyroidism by impairment of CaR activity and, by the same token, can be linked to the development of not only osteoporosis and various malignancies, but possibly other calcium-insufficiency-related chronic diseases (Table 1) (for details, [1,3]; see also Figure 2).
Relevant for our understanding how vitamin D and calcium status interact in the pathogenesis of chronic diseases, is the observation that most cell types jointly express the 25-(OH)D-1α-hydroxylase and the CaR. Therefore, cell-specific cooperative signalling from 1,25-(OH)2D3/VDR and CaR, which is necessary to maintain normal cell functions (as detailed in [1,3]), is impaired under conditions of vitamin D and calcium insufficiency (Figure 2). This has been shown particularly for osteoporosis and many malignancies, particularly colorectal and breast cancer (as detailed in the following). Low serum 25-(OH)D and inadequate calcium intake reportedly are associated with cardiovascular risk factors such as hypertension [25–27], obesity [28–30], metabolic syndrome and diabetes mellitus type II [31,32]. Vitamin D and calcium insufficiencies have also been correlated with incident cardiovascular symptoms, including angina, coronary insufficiency, myocardial infarction, transient ischemic attack, and stroke [33], as well as with greater mortality from chronic cardiovascular disease [19,34,35].
3. Vitamin D Insufficiency: A World-Wide Phenomenon
3.1. Definition of Vitamin D Insufficiency
The vitamin D status of an individual is a composite of UV-B mediated synthesis of vitamin D3 in the epidermis and of intake and absorption from the gut. Outright vitamin D deficiency is indicated by plasma 25-(OH)D levels below 10–15 nM [36]. In this situation, 1,25-(OH)2D production in the kidney is severely limited because of substrate depletion, causing a decrease in intestinal calcium absorption with rickets or osteomalacia as a consequence. At 25-(OH)D serum concentrations above 15 nM, the kidney produces enough 1,25-(OH)2D3 to maintain systemic mineral ion homeostasis [37], but availability of 25-(OH)D for intracellular production of 1,25-(OH)2D3 at extra-renal sites may be insufficient for autocrine/paracrine control of cellular functions [1]. The definition of vitamin D insufficiency is still a matter of debate. At one time, a serum 25-(OH)D concentration of ~30 nM was thought to be the delimitation between vitamin D insufficiency and adequate vitamin D supply [38]. Now there is growing agreement that serum 25(OH)D should be at least 50 nM [39] (see also Tables 2–4). Even higher cut-offs, e.g. 60–100 nM, are supported by studies on optimal health outcomes [40].
3.2. Epidemiology of Vitamin D Insufficiency
Considering reasons for vitamin D insufficiency, one has to take into account that cutaneous UV-B-mediated production of vitamin D3 is affected by many factors, such as time of the day, season of the year, latitude, altitude, skin pigmentation or use of sunscreens. Also aging can markedly reduce the capacity of the skin to produce vitamin D3 [41]. Geographical differences in vitamin D status result from varying contributions to the vitamin D supply from exposure to solar UV-B but also from intake of dietary and supplemental vitamin D [42,43]. Table 2 lists the results of the available nationally representative studies on prevalence of vitamin D insufficiency in the normal adult population in Europe, North America, East Asia and in the South Pacific area.
In Europe, 7–27% of the adult population have a serum 25-(OH)D concentration below 25–30 nM [26,38,44–47]. In South-East Asia and in Australia, incidence of vitamin D insufficiency varies between 8–17% [48–50]. A relatively low value of 5% has been reported for the USA [51]. However, if 50 nM 25-(OH)D is considered the upper reference limit, on the average one-half of the adult population in Europe [26,38,44–47], Western Canada [52], Australia [53,54] and New Zealand [55] presents with vitamin D insufficiency, whereas only one-third is afflicted in the USA [51] (Table 2).
It must be noted that the proportion of the general population with serum 25-(OH)D below the desirable level of 70–80 nM [40,56] is 73% in the USA [51], 84–87% in Europe and in the South Pacific area [44,46,55] and up to 97% in Canada [52].
3.3. Vitamin D Insufficiency in Different Population Segments
Elderly people: It has been known for decades that vitamin D insufficiency is common in people, who are immobilized because of chronic diseases or are housebound due to old age. However, recent nationally representative data show that vitamin D insufficiency is present in a substantial portion of old age ambulant people worldwide (Table 3): For example, the European SENECA Study on diet and health of elderly people from 19 towns in 12 European countries revealed that overall 36% of men and 47% of women had serum 25-(OH)D concentrations below 30 nM [57]. In the Netherlands, 50% of people aged 65 years and older had serum levels of 25-(OH)D below 50 nM [58]. Similar values were reported for elderly women in Belgium [59]. According to the OPTIFORD Study [60], 50–92 % of elderly women in Denmark, Finland, Ireland and Poland had wintertime 25-(OH)D concentrations lower than 50 nM. On the average, prevalence of vitamin D insufficiency in elderly people in North America [51,61], Australia [62], New Zealand [55] and Japan [63] seems to be lower than in Europe (Table 3).
Children, adolescents and young adults: In some European countries such as Denmark, Finland, Ireland and Poland [60], 37% of 12-year old girls had 25-(OH)D concentrations lower than 25 nM (Table 4). By using a broader definition, i.e., <50 nM, 92% had to be considered vitamin Dinsufficient. Comparative values are much lower in Germany [64], but considerably higher in France [65].
In the USA, the proportion of male and female adolescents between 12–19 years, who had 25-(OH)D values below 50 nM, ranged from 24 to 31%, respectively [51]. Incidence of vitamin D insufficiency in younger women is low in Canada [66], compared to Indonesia, Malaysia [67] or Japan [50]. Alarmingly high rates were found in older girls and young women at child-bearing age in India [68] and China [69,70] (Table 4).
Pregnant women and neonates: In Europe and in the USA, a poor vitamin D status is observed with increasing frequency in pregnant women [71] and consequently in their neonates causing a high risk of not only rickets, but also non-skeletal diseases in later life, e.g. type 1 diabetes [72].
Obesity deserves a special note as a condition frequently associated with vitamin D and calcium insufficiency. A number of earlier studies have well documented a high prevalence of vitamin D insufficiency in morbidly obese women. Now evidence is emerging that in otherwise healthy women and men, body fat mass is frequently inversely associated with vitamin D insufficiency [29,73]. Sequestration of vitamin D in the subcutaneous fat, which alters its release into the circulation, could be one by which obesity could contribute to vitamin D insufficiency [74].
Ethnic groups: The immigrant population is at high risk for vitamin D insufficiency in many European countries such as Denmark, Norway and Great Britain [75–77]. In Germany, the proportion of vitamin D inadequacy in children and adolescents, aged 2–17 years, is higher in immigrant than in non-immigrant girls and boys at any time. Notably, after termination of vitamin D supplementation for prophylaxis of rickets between the age of 1–2 years, serum 25-(OH)-D levels fell rapidly below 50 nM in both groups [64]. In the USA, prevalence of vitamin D insufficiency in Mexican American and Non-Hispanic black people is higher than in Non-Hispanic White individuals [51]. Analogous skin pigmentation and degree of vitamin D inadequacy has been reported for three ethnic groups in New Zealand, i.e., Pacific people, Maori and people of European origin [55]. In Australia, dark-skinned and "veiled" women, particularly when pregnant, belong to the group with the highest risk for vitamin D insufficiency [78].
4. Inadequate Calcium Intake: A World-Wide Problem
4.1. Recommended Calcium Intake Levels
Different intake levels for calcium are recommended by FAO/WHO experts for infants, children and adults [79] to assure optimal whole body calcium retention and consequently adequate development and maintenance of bone mass and mineral density. For children and adolescents between 10–18 years of age, consumption of 1,300 mg per day is recommended, while 1,000 mg per day apply for men between 25–50 years of age and also for women in the same age group, except when higher intake is necessary during pregnancy or after menopause. Recommended calcium allowance per day for males over 65 years and postmenopausal women is 1,300 mg [79].
4.2. Epidemiology of Calcium Intake
Findings listed in Table 5 indicate that in Europe daily calcium intake from nutrient sources is consistently low. For example, 84% of the adult population in Austria fail to meet recommended intake levels [44]. The situation is apparently better in Germany [80,81], with one study reporting daily calcium intake even at recommended levels [26]. This seems to be also the case in Great Britain [82].
In contrast, 40% of the population does not meet adequacy in the USA [83]. Similar values probably pertain for Australia [84] and New Zealand [85]. Special consideration must be given to the nutritional calcium deficit in South-East Asian countries such as Indonesia, Malaysia [67] and Bangladesh [86]: The situation is particularly alarming in Bangladesh, where 47% of premenopausal women in the higher socio-economic brackets failed to meet a daily allowance of 400–500 mg calcium, and 63% of women of low socio-economic standing had calcium intake even lower than 200 mg/day [86].
4.3. Population Segments with Low Habitual Calcium Intake
Chronically ill people: A chronically negative calcium balance due to malabsorption develops, for example, in the many individuals suffering worldwide from lactose intolerance or from inflammatory bowel disease (Crohn's disease, ulcerative colitis). In addition, calcium malabsorption must be reckoned with in all cases of vitamin D insufficiency resulting from intestinal, hepatic, renal or endocrine disorders as well as in the group of bariatric surgery patients who increase in numbers as a result of the obesity epidemic in the affluent parts of the world.
Individuals with reduced physical activity: It must be noted that immobilization even for a short period, e.g. 1–2 weeks of bed rest leads to mobilization of calcium from bone and consequently to net calcium loss [87]. Therefore not only patients in geriatric, psychiatric or neurological care, but also healthy individuals with low habitual physical activity have an increased risk of calcium insufficiency.
Elderly people: The data collated in Table 6 confirm the long-standing assumption that particularly the elderly ingest significantly less calcium in their diet than the recommended amount, which is currently considered 1,300 mg per day for this age group [79]. In the European SENECA Study [88], the overall mean calcium intake by elderly people was 894 mg per day, with variations from 600–1,100 mg between different study sites. In the OPTIFORD Study, the median calcium intake among elderly women was 632 mg per day, being lowest in Poland (325 mg) and highest in Finland (925 mg) [60]. In the USA, the mean intake of calcium in women after age 55 is only ~600 mg/day [61]. Daily consumption of ~500 mg by elderly Japanese women [89] is far below a recommended level of 1,200 mg, although daily calcium requirements of East Asian populations may be lower for ethnic reasons [79].
Children, adolescents and young adults: In the European OPTIFORD study the median daily calcium intake of girls at a mean age of ~13 years was 823 mg, ranging from 524 mg in Poland to 1,092 mg in Finland [60] (Table 7). Data from the USA indicate that after the age of 10, calcium malnutrition is a common phenomenon. For example, average daily calcium intake in a group of young adolescents (12.7 ± 1.0 yr of age) was found to be 906 mg [90]. Grossly inadequate calcium intake was observed also in young adults in Canada [91]. Average daily calcium intake by schoolgirls in India between 400–500 mg [68], though corresponding to recommended daily allowances for Indians, nevertheless is far below current FAO/WHO recommendations of 1,000–1,300 mg/day [79].
Ethnic groups: It has to be borne in mind that not only vitamin D deficiency but also a nutritional calcium deficit is an important cause of rickets [92]. So-called calcium deficiency rickets are prevalent in Middle Eastern and many sub-tropical and tropical countries, such as Nigeria, Ethiopia, South Africa, India and Bangladesh, despite the fact that such countries have ample sunlight [93–95]. Under this condition, the disease is attributable to low dietary calcium intake from mainly cereal-based diets.
5. Strategies for disease prevention
Studies on the vitamin D intake in different parts of the world cannot be directly compared because results may be confounded to some extent by differences in life style and clothing habits, consumption of traditional foods or supplement intake. Exact determination of the extent of calcium malnutrition is also difficult, because different methods are used for evaluation of daily calcium intake from nutrient sources and, in addition, for ethnic, dietary and geographical reasons different recommendations apply for different parts of the world [79]. However, combined evidence from all the studies that are included in the present survey clearly indicates that vitamin D insufficiency and calcium malnutrition are common in both genders worldwide, not only in elderly people as previously believed but also in younger adults. Importantly, the highest rates of insufficiencies are found in children and adolescents as well as in women of child bearing age.
5.1. Need to Increase Combined Intakes to Daily 800 IU Vitamin D and 1,200 mg Calcium
Vitamin D: A recent survey on world-wide vitamin D intake [96] clearly indicates that in many countries vitamin D supply from nutrient sources is too low to sustain mean 25-(OH)D levels in the general population between 40–100 nM, which are considered sufficiently high to achieve a better health outcome [97]. Cashman et al. [98] calculated that in 20–40 yr old adults, depending on the extent of sun exposure in summer, daily intakes of vitamin D between 300 and 1,600 IU are required to maintain an adequate vitamin D status in wintertime. Notably, Nelson et al. [56] reported that daily doses of 800 IU vitamin D3 were sufficient to sustain "optimal" 25-(OH)D serum concentrations (≥75nM) in 80% of a group of pre-menopausal women. With approximately the same daily dose of vitamin D3, serum 25-(OH)D levels could be maintained at 50 nM in 97.5% of a group of elderly people in the absence of sufficient sun exposure [99]. The beneficial effects of 800 IU supplemental vitamin D for various health outcomes are well documented. Daily intake of 700–800 IU vitamin D3 maintains normal bone turnover in healthy men at wintertime [100], and reduces the risk for colorectal or breast cancer by 50% [101,102].
Calcium: The suggestion to raise daily consumption of calcium to an average of 1,200 mg per day is based not only on physiological considerations [103] but can be deduced also from considerations of optimal health outcomes: For example, daily doses of 1,200 mg calcium effectively prevent osteoporotic bone loss and fractures in people aged 50 years or older [104], and cause a 40–50% risk reduction of colorectal cancer in men and of breast cancer in premenopausal women [105,106].
5.2. Rationale for Advocating Combined Intake of Vitamin D and Calcium
Simultaneous correction of nutritional vitamin D and calcium deficits for prevention or amelioration of many chronic diseases is necessary for two reasons: First, dietary intakes of vitamin D and calcium are strongly associated [107] and therefore vitamin D insufficiency is frequently associated with low calcium intake [1,44]. Second, because vitamin D and calcium interact positively in modulation of cellular proliferation, differentiation and function, as detailed before [3,18], it can be expected that an adequate vitamin D status is required to achieve the nutritional benefits of calcium and vice versa.
Osteoporosis: Combined supplementation with daily 800 IU vitamin D and 1,200 mg calcium is the essential basis for pharmacological prevention and treatment of osteoporosis. From a meta-analysis of 10 randomized controlled trials of oral vitamin D with or without calcium supplementation vs placebo/no treatment on the risk of hip fracture in elderly people, Boonen et al. [108] concluded that oral vitamin D appears to reduce the risk of hip fractures only when calcium supplementation is added.
Cancer: Lappe et al. [109] reported evidence from a randomized placebo-controlled trial that in post-menopausal women combined high-dose calcium and vitamin D3 supplementation, i.e., 1,400–1,500 mg calcium plus 1,100 IU vitamin D3, reduced the cumulative risk of cancer of the breast, lung, colon, uterus, lymphoid and myeloid system to 0.232 after four years of trial. Cho et al. [110] concluded from an analysis of pooled primary data from 10 cohort studies with a follow-up of more than half a million individuals for 6–16 years, that optimal risk reduction for colorectal cancer necessitates high intake levels of both vitamin D and calcium. This notion was shown to be valid not only for Western but also for Asian populations [111]. In pre-menopausal women, Bérubé et al. [112] found highly significant inverse relations between total intakes of vitamin D and calcium and breast density, which is a surrogate marker for breast cancer risk. It is noteworthy, that higher intake of one nutrient was related to lower breast density only in the presence of higher intake of the other nutrient.
6. What can be Done?
Simultaneous supplementation of vitamin D and calcium represents a safe and inexpensive strategy for prevention of osteoporosis, colorectal and breast cancer and possibly of many other chronic diseases (Table 1). It must be emphasized that daily consumption of 800 IU vitamin D and 1,200 mg calcium is well below the currently accepted tolerable upper intake levels of 2,000 IU (=50 μg) vitamin D3 and 3,000 mg calcium [79].
6.1. Supplementation by Fixed Vitamin D/Calcium Combination Tablets
Osteoporotic fractures can be effectively prevented at relatively low cost by combined supplementation with 1,200 mg/d calcium and 800 IU/d vitamin D3. However, a significant effect of vitamin D/calcium treatment is only seen in cohorts with at least 80% compliance [104]. Low compliance and lack of adherence seen with any long-term medication certainly will limit the usefulness of combined vitamin D and calcium supplementation for correction of respective insufficiencies in the general population. Therefore, combined vitamin D and calcium supplementation should be promoted specifically for disease prevention in high risk groups, i.e., individuals, who otherwise are unable to attain a normal vitamin D and calcium status due to specific living conditions (immobilization, physical incapacitation, advanced age, chronic diseases), traditional or personal nutritional habits, preferred lifestyle (lack of physical activity, indoor dwelling) etc.
6.2. Vitamin D and Calcium Enrichment in Single Foodstuffs
Fortified foods are an important source of vitamin D for those who consume them [113]. In a recent survey on the efficacy of food fortification on serum 25-(OH)D concentrations [114], dose-effect relations for vitamin D from food sources were found equivalent to those reported for vitamin D supplements. Vitamin D-fortified milk has been found to be a safe, effective and acceptable method of administering vitamin D, particularly to the elderly, community-based population. Orange juice fortified with vitamin D2 (1,000 IU/240 ml) was tested for its suitability to serve as an alternative for vitamin D-fortified milk. Fortification with vitamin D3 of wheat and rye bread is technically easy, and stability and bioavailability of vitamin D is good [115]. Consumption of bread fortified with 5,000 IU vitamin D3 and 320 mg calcium per daily serving for 12 months improved the vitamin D status of sun-deprived nursing home residents. Together with suppression of secondary hyperparathyroidism this apparently caused a significant increase in bone mineral density at the lumbar spine and the hip [116].
Calcium fortification is in use all over the world: Staples and food stuffs that are enriched with calcium include flour, cereals, milk, orange juice, mineral waters, soymilk etc. [117]. Calcium- and vitamin D-fortified milk, when providing 800 IU vitamin D and 1,000 mg calcium per day, has a significant positive effect on bone mass and strength in older men [118,119].
It is apparent that fortification of traditional and widely consumed foodstuffs (milk and milk products, bread, orange juice etc.) will guarantee a minimum additional supply of vitamin D and calcium.
6.3. Vitamin D and Calcium Addition to Cereal Grain Products
At present, cereal grain products, such as flour, corn meal, noodles and the like, are enriched with vitamin D and calcium in some countries in Europe and in the USA. Newmark et al. [117] summarized the rationale, data, efficacy, safety, cost and practicality of the addition of both calcium and vitamin D to cereal grain products to reduce the risk of osteoporosis and colon cancer. The authors estimate that, if cereal grain products were uniformly enriched with 90 IU/100g vitamin D, average daily intake of vitamin D could increase by up to 200 IU vitamin D. Enrichment of cereal grain products with 1,200–1,800 mg/kg calcium could raise dietary intake by about 200–400 mg/day. A conservative estimate suggests that through these measures at least a 20% reduction of the rate of osteoporotic fractures and of colorectal incidence can be achieved [117].
Enrichment of cereal grain products with vitamin D and calcium at indicated levels would be possible within current legal regulations in the USA [117]. It also conforms to legislation introduced in the European Union as of 2007. However, some important member states such as Germany have not yet changed their national law accordingly.
In summary, enrichment with vitamin D and calcium of cereal grain products is an effective and safe measure at very low cost to broaden the range of commonly consumed foods as dietary sources of vitamin D and calcium. This will guarantee at least some modest improvement in both vitamin D and calcium nutrition at the same time without necessitating a change in traditional eating habits. To fulfill individual needs for vitamin D and calcium however, additional consumption of particularly vitamin D- and calcium-rich food and food products or even supplement use is certainly indicated.
We thank Sandra E. Guggino, Johns Hopkins University Medical School (Baltimore, USA) for critical reading of the manuscript.
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|Table 1. Rating of evidence for association of vitamin D and/or calcium insufficiency with frequent chronic diseases (for details, [1,3]).
|Vitamin D insufficiency
|Nutritional Calcium deficit
|A. Convincing evidence from multiple epidemiological (prospective, cross-sectional, retrospective) large cohort studies, interventional trials and experimental studies
|Cancer (colorectal, breast)
|Cancer (colorectal, breast)
|B. Good evidence from >3 observational studies and/or interventional trials
|Cancer (renal, prostate, endometrial, ovarian, esophageal, gastric, pancreatic, bladder) Hodgkin's and non-Hodgkin's lymphoma
|Cancer (renal)
|Cardiovascular disease
|Cardiovascular disease
|Neuromuscular dysfunctions
|Neuromuscular dysfunctions
|Diabetes mellitus Type I
|Periodontal disease, tooth loss
|Periodontal disease, tooth loss
|C. Emerging evidence from observational studies
|Metabolic Syndrome
|Metabolic Syndrome
|Diabetes mellitus Type II
|Diabetes mellitus Type II
|D. Evidence mainly from studies with animal models of the respective human disease
|Inflammatory bowel disease
|Inflammatory bowel disease
|Multiple Sclerosis
|Multiple Sclerosis
|Table 2. Prevalence of vitamin D insufficiency in healthy adults in selected countries.
|Population segment
|% Vitamin D insufficiency
|with upper reference limit at
|Age (yr)
|25–30 nM
|50 nM
|Kudlacek et al. [44]
|Brot et al. [45]
|Lamberg–A. et al.[47]
|Chapuy et al. [38]
|Hintzpeter et al. [26]
|Hypponen & Power [46]
|North America
|Canada (Alberta)
|Rucker et al. [52]
|Looker et al. [51]
|South–East Asia
|12 – 17
|Islam et al. [48]
|Nakamura et al. [50]
|South Pacific
|Australia (Queensland)
|8 a)
|McGrath et al. [49]
|Australia (Queensland)
|Van der Mei et al. [54]
|Australia (Victoria)
|Pasco et al. [53]
|Australia (Geelong)
|Van der Mei et al. [54]
|Australia (Tasmania)
|Van der Mei et al. [54]
|New Zealand
|Rockell et al. [55]
a)Serum 25-(OH)-D <38 nM
|Table 3. Prevalence of vitamin D insufficiency in elderly people.
|Population segment
|% Vitamin D insufficiency
|with upper reference limit of serum 25-(OH)D at
|Age (yr)
|25–30 nM
|50 nM
|76.5 ± 7.5
|Neuprez et al. [59]
|Andersen et al. [60]
|Andersen et al. [60]
|Andersen et al. [60]
|v. d. Wielen et al. [57]
|Wicherts et al. [58]
|Andersen et al. [60]
|v. d. Wielen et al. [57]
|North America
|Lappe et al. [61]
|Looker et al. [51]
|East Asia
|Nakamura et al. [63]
|South Pacific
|Flicker et al. [62]
|New Zealand
|Rockell et al. [55]
|Table 4. Prevalence of vitamin D insufficiency in children, adolescents and young adults.
|Population segment
|% Vitamin D insufficiency
|with upper reference limit of serum 25–(OH)D at
|Age (yrs)
|25–30 nM
|50 nM
|Hintzpeter et al.[64]
|Hintzpeter et al. [64]
|Guillemant et al. [65]
|Andersen et al. [60]
|Andersen et al. [60]
|Andersen et al. [60]
|Andersen et al. [60]
|North America
|Looker et al. [51]
|Looker et al. [51]
|Vieth et al. [66]
|South–East Asia
|India (Delhi)
|6 – 18
|Puri et al. [68]
|Woo et al. [70]
|Foo et al. [69]
|Green et al. [67]
|Green et al. [67]
|Nakamura et al. [50]
|South Pacific
|New Zealand
|Rockell et al. [55]
|New Zealand
|Rockell et al. [55]
|Table 5. Nutritional calcium deficit in selected countries.
|Age (yrs)
|DRI a) (mg/day)
|Calcium intake (mg/day)
|561 (±290) b)
|576 (±309) b)
|Kudlacek et al. [44]
|604 (±345) b)
|560 (±299) b)
|Kudlacek et al. [44]
|590 (±318) b)
|561 (±287) b)
|Kudlacek et al. [44]
|1,181 (902–1,535)
|1,082 (849–1,379)
|Hintzpeter et al. [26]
|619 (213–1,025)
|705 (313–1,094)
|Anke [80]
|774 (334–1,330) c)
|707 (287–1,225) c)
|Schulze et al. [81]
|UK f)
|1,133 (950–1,316)
|1,063 (931–1,195)
|Vyas et al. [82]
|North America
|812 (788–837)
|626 (596–659)
|Ma et al. [83]
|South–East Asia
|16 – 40
|180 e)
|Islam et al. [86]
|270 (239–302) d)
|Green et al. [67]
|386 (353–420) d)
|Green et al. [67]
|South Pacific
|643 (±340) b)
|Pasco et al. [84]
|New Zealand
|794 (8–1,580) e)
|Metcalf et al. [85]
a)Daily Recommended Intake by FAO/WHO [79];b)mean (±SD);c)median (90% CI);d)median (95% CI);e)mean (range);f)white, urban population
|Table 6. Nutritional calcium deficit in elderly people.
|Calcium intake (mg/day)
|Age (yrs)
|DRI (mg/d)a)
|503 (±221) b)
|569 (±287) b)
|Kudlacek et al. [44]
|748 (324–1,166) c)
|676 (287–1,101) c)
|Amorim Cruz et al. [88]
|544 (127–1,812)d)
|Andersen et al. [60]
|975 (404–2,313) d)
|Andersen et al. [60]
|620 (402–1,010) c)
|635 (428–944) c)
|Amorim Cruz et al. [88]
|824 (339–1,669) d)
|Andersen et al. [60]
|1,036 (725–1,447) c)
|1,010(612–1,616) c)
|Amorim Cruz et al. [88]
|325 (86–851) d)
|Andersen et al. [60]
|North America
|611 (381–892) c)
|Lappe et al. [61]
|South–East Asia
|527 (±195) b)
|Nakamura et al. [89]
a)Daily Recommended Intake by FAO/WHO [79];b)mean (± SD;c)mean (range);d)median (97.5% CI)
|Table 7. Nutritional calcium deficit in children, adolescents and young adults.
|Calcium intake (mg/day)
|Age (yr)
|DRI a) (mg/day)
|831 (260–2,475) b)
|Andersen et al. [60]
|1,092 (546–2,452) b)
|Andersen et al. [60]
|728 (54–2,259) b)
|Andersen et al. [60]
|524 (117–1,580) b)
|Andersen et al. [60]
|North America
|906 (417–1,616) c)
|Abrams et al. [90]
|562 (0–2,630) c)
|Rubin et al. [91]
|South-East Asia
|India (Delhi)
|575 (±219) d)
|Puri et al. [68]
a)Daily Recommended Intake by FAO/WHO [79];b)median (97.5% CI);c)mean (range),d)mean (±SD)
© 2009 by the authors; licensee Molecular Diversity Preservation International, Basel, Switzerland. This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).


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When the Steelers' brass signed Fernando Velasco, Shayne Graham, and Jonathan Dwyer yesterday, their front office had to either release three players or place three on injured reserve. Since Pittsburgh lost three players to season-ending injuries on Sunday afternoon, the choice was an easy one for Kevin Colbert & co..
According to the team's website, the Steelers placed Maurkice Pouncey, Larry Foote, and LaRod Stephens-Howling on "IR" for the rest of the season. Those moves almost doubled the total number of players on the team's "IR" from four to seven, and those three joined Plaxico Burress, Justin Cheadle, Nik Embernate, and Nick Williams who already populated the list.
Although the four already on "IR" were not expected to contribute very much on the field this fall, the losses of two starters and the team's projected "third down back" are nothing short of disastrous for the franchise. Although the Steelers are not a "playoff-caliber" team in my opinion, they can ill afford to lose their most experienced members during what is sure to be a rebuilding season.
If this list continues to grow, especially with Pro Bowl players like Pouncey, then phrases like "Downey for Clowney" might become more commonly uttered as the season wears on in Pittsburgh.
Stats & Info. Provided By: ESPN.com, Steelers.com and Pro Football Reference
Follow me on Twitter: @DominicDiTolla
Follow & Like "NPC" on Facebook: Nice Pick, Cowher
Tags: Injured Reserve Justin Cheadle LaRod Stephens-Howling Larry Foote Maurkice Pouncey Nick Williams Nik Embernate Pittsburgh Steelers Plaxico Burress

subset: commoncrawl


text: Riding The Tiger "I discovered that being a President is like riding a tiger. A man has to keep on riding or be swallowed." Harry S. Truman Posted September 13, 2012 By Carah Ong Americans, Libyans Deserve Better than Politicization of Attacks J. Christopher Stevens, U.S. Ambassador to Libya, who was killed in an attack on the U.S. consulate in Benghazi, Libya, on September 11, 2012. Photo courtesy of State Department. Once again the polarized political environment is trumping serious real-world issues. On Tuesday, a truly genuine human being, Ambassador Chris Stevens, died during an attack on the U.S. consulate in Benghazi, Libya perpetrated by a group with extremist ties. The group took advantage of people demonstrating against a film offensive to Muslims to carry out the attack. New reports suggest that the attacks in both Libya and Cairo were timed for the commemoration of the September 11, 2001 attacks and in retaliation for U.S. drone strikes and attacks on Al Qaeda earlier this year. When I worked in Washington D.C., I had the opportunity to meet with Chris on a few occasions to discuss U.S. policy toward Iran and Libya. At our first meeting in Spring 2007 when he was working on an exchange from the State Department in a Senate office, Chris learned that I had traveled Libya as part of civil society exchange soon after U.S. sanctions against the country were lifted in 2003, and again in 2005. He asked to meet with me again to learn all he could about my experiences in the country before he was set to take up a diplomatic post there that year. He was truly interested in learning about the Libyan culture and was intent on improving American-Libyan relations, as well as Arab-American relations more broadly. As one of my former DC colleagues wrote today, Chris was precisely the right person to serve as U.S. Ambassador. He was an excellent representative of the United States, a gifted foreign service officer, and he will be missed. The tragic killing of Ambassador Stevens and three of his staff sheds some light on the situation on the ground and the gaps in security. Before September 11, 2012, many journalists and pundits tried to paint a rosy situation in Libya. But the reality on ground for the people living there is far different. One of my contacts in Libya whom I met on my first trip to the country, Ibrahim, emailed me this message: The situation is not OK at all. Peoples' hopes from the 17 February change (the Libyan revolution) have not been met. There is a real serious threat of civil war that is so obvious and it is only a matter of time if things keep on going this way. It's so sad, no one is really in control of any thing. The western world has forgotten about human rights in Libya at this time and people are really questioning the real intentions of the USA and Europe. It will take more than a speech to improve Arab-American relations and to improve the situation on the ground for the beleaguered peoples in the Middle East. However, instead of using the tragedy of September 11, 2012 as means for addressing how the United States will work with allies and partners to do so, the parties have instead engaged in partisan bickering. The American people and the Libyan people deserve better from politicians than the politicization of the tragic attacks. Read more → Foreign Policy Middle East 2012 Election Tweet Posted September 11, 2012 By Carah Ong Does Jerusalem Matter In the 2012 Election? President Barack Obama and Israeli Prime Minister Benjamin Netanyahu deliver a press conference following their meeting in the Oval Office. Screen-shot from official White House video. May 18, 2009. PD, courtesy of Executive Office of the President. Last week a bit of controversy erupted on the Democratic Convention floor when the delegates were asked to vote on amending the platform to include God and recognition of Jerusalem as Israel's capital. Politico reported that President Obama himself ordered his staff to make the change after Republicans seized on both to attack the President and the party. Democratic and Republican presidents alike have considered recognition of Jerusalem part of the final status negotiations. From Harry S. Truman through the presidency of George H.W. Bush, every president opposed Israel's expansion in Jerusalem and asserted that the city should remain undivided. However, for Democrats, official American policy upheld by presidents has differed from the party positions since 1972, when the party platform called for recognizing the "established status of Jerusalem as the capital of Israel" and called for relocating the American embassy from Tel Aviv to Jerusalem. With the exception of the 1988 Democratic Party platform in which Jerusalem was not mentioned even once, the Democratic Party was the first to call for recognition of Jerusalem and has maintained this position since. Presidential policy positions on Jerusalem shifted with the presidency of Bill Clinton. The Clinton administration essentially gave Israel a de facto green light for settlements in East Jerusalem, and the Clinton Parameters, established in 2000, broke from the long-standing position that Jerusalem remain an open city. The 2012 Democratic Party position emphasizes that Jerusalem is part of final status negotiations for the first time since the party's began taking a position on the issue 40 years ago. This language is not surprising given that President Obama himself ordered the change to the party platform. Read more → Conventions Foreign Policy 2012 Election Tweet Posted September 7, 2012 By Amber Lautigar Reichert Friday Feature: President Clinton Not Riding a Tiger Clinton on horseback, near Billings, MT, 1996 Former President Bill Clinton made quite a showing this week at the DNC. Here's a shot from a rare quiet moment during his presidency. Stay tuned! Every Friday we'll highlight an interesting item from presidential history. Not Riding a Tiger Tweet Posted September 7, 2012 By Carah Ong Party Animals or the Top Eleven Things I Learned at the Democratic Convention 1. No one can out-perform Bill Clinton, not the NFL or even a sitting president with incomparable rhetorical skills. Clinton soaked up the spotlight and enjoyed every moment of it. His speech reminded me of the 2000 SNL skit in which Clinton, following a presidential debate between Al Gore and George W. Bush, assures Americans he is doing everything he can to find a way to be president again. Obama's appearance on stage at the conclusion of Clinton's speech was almost necessary to remind the public that he's the one running for president. 2. If your expectations for a speaker are high, you may be disappointed by actual performance. In the case of President Obama, for example, many expected to hear specifics about his second term policy agenda. Instead, we basically heard an amalgamation of speeches from the previous nights, featuring a laundry list of party positions and Democratic themes. As Larry Sabato aptly put it, it was nothing more than a glorified stump speech. 3. If your expectations for a speaker are low, you may be pleasantly surprised. John Kerry was on fire last night. I might have even paid to see his performance as a stand-up comedian, with his delivery of lines such as, "Ask Osama bin Laden if he's better off now than he was four years ago." Poking fun at Romney's shifting positions on Iraq and Libya, Kerry said, "Talk about being for it before you were against it." Another highlight: "For Mitt Romney, an overseas trip is what you call it when you trip all over yourself overseas. It wasn't a goodwill mission – it was a blooper reel." He could have topped his speech off with a line like, "For Mitt Romney, an overseas trip is visit to the ATM" or by asking "Will you elect a flip-flopper from Massachusetts?" 4. As a California delegate complained to me, the Convention was too focused on the president, his policy positions and policy accomplishments. Welcome to the presidency-centered programmatic party system that has been developing since FDR, with roots in TR's presidency. As the California delegate pointed out though, Congressional races matter if the president wants to implement his second-term policy agenda. 5. For probably the first time in nearly half a century, the Democratic Party had an edge on national security and foreign affairs. And believe me, they milked it for all it was worth. However, it really was one important difference between the Republican and Democratic conventions. The Democrats emphasized Veterans and of course touted Bin Laden's death, as well as action in Libya. Furthermore, the Democrats linked foreign policy with domestic policy, arguing that war and peace, and rich and poor, drive social issues domestically. Meanwhile, we barely heard any mention of foreign policy at the Republican convention, Condi Rice aside. Nor have the Republicans explained why they are calling for 100,000 new troops in their party platform or what they plan to do with them. Read more → Conventions 2012 Election Tweet Posted September 6, 2012 By Carah Ong Convention Round-up Day Two Rep. Ed Markey (Massachusetts) delivers a keynote address during an event for convention delegates on the Obama administration's national security policy sponsored by the Council for a Livable World. 9/5/2012. Photo by Carah Ong. In this post, I offer some highlights from the second day of the convention floor. Stay tuned for a round-up of unconventional highlights. Day two of the convention was filled with partisan appeals and once again focused on the policy accomplishments and positions of the Obama administration. The main thrust of the speeches was to convey the election as a choice over the future of the middle class, the American Dream and "shared opportunity, shared responsibility, all-in-it-together society." Sandra Fluke and Libby Bruce, among others, discussed what a Romney presidency would mean for women's rights. Rep. Chris Van Hollen (Maryland) drove home the differences in economic policies of the two presidential candidates, noting that the election is a choice that "will determine whether America is a place where people climb the ladder of opportunity and pull it up behind them or whether America is a place where people who reach the top help the next person up." Rep. Nancy Pelosi (California) also called this election a choice not only of candidates, but also of issue positions: Many names are on the ballot. So, too, is the character of our country…Medicare is on the ballot…Social Security is on the ballot…The hard-won rights of women are on the ballot…Our democracy is on the ballot. Democrats believe we must curb the influence of special interests on our political institutions…The American dream is on the ballot. Ladders of opportunity for our middle class are on the ballot. Bill Clinton was by far the star of the evening, if not the convention thus far, engaging in partisan warfare. I predict that with his current favorability rating (coming in around 69%), Clinton's attack dog performance will contribute to any convention bump President Obama receives. Read more → Conventions 2012 Election Tweet Posted September 5, 2012 By Emily J. Charnock An Expanding Ex-Presidency President Obama and former President Clinton on June 4, 2012. (Official White House Photo by Pete Souza) When Jimmy Carter delivered his video message to the Democratic National Convention yesterday, he did so as the second-longest serving ex-president of all time. By the end of this week, he will be the longest-serving, exceeding Herbert Hoover's 31 years and 232 days out of office – and building a compelling record of humanitarian endeavor along the way. But it is the former president appearing at the convention tonight – Bill Clinton – whose expanding ex-presidency threatens to steal the show. And not just from Carter, but from the incumbent president whose campaign he is aiming to bolster. Read more → Conventions 2012 Election Tweet Posted September 5, 2012 By Carah Ong Convention Round-up Day One: Democrats Offer Their Vision for the American Dream The first evening of the Democratic Convention was filled with speeches driving home the first term policy accomplishments of President Barack Obama and values that undergird those policies. We heard a lot about the differences between the candidates on range of policies including Medicare, foreign policy, immigration, and tax policy. Nearly all of the speakers drove home the importance of the President's healthcare bill, but this was especially the case for a family whose daughter had a congenital heart condition and, thanks to Obamacare, would now receive the coverage they needed. The main theme running through the various speeches was the Democratic Party's interpretation of the American Dream – which requires an active role for government, government investment and individual contributions to become a reality. Read more → Conventions 2012 Election Tweet Posted September 4, 2012 By Carah Ong More than Pre-Packaged Speeches: The importance of outside events to modern conventions Protest of undocumented immigrants outside of the convention hall in Charlotte, North Carolina. September 4, 2012. Photo by Carah Ong. CHARLOTTE, NC. --- Those who claim that the party conventions have become nothing more than pre-packaged speeches are missing an entire element of what modern conventions are about. Inside the convention halls, yes the parties put forward a line-up of loyal speakers to promote their candidate, party and platform. But outside the convention halls, interest groups (as well as lobbyists and businesses) are engaging in a whole range of activities that aren't necessarily observed by the mainstream media or by political scientists. Yet, these activities make an important contribution to the role of conventions in modern elections. At least in Charlotte, it's not solely about the formal speeches or promoting the Democratic Party. The convention is also an event around which individuals and interest groups have the opportunity to organize, strategize and express public opinion. Such activities outside the formal convention are just as important to observe and monitor because they raise issues that you may not hear about in the official party agenda and they provide an opportunity for all individuals, not just the party loyal, to engage in political expression. Read more → Conventions 2012 Election Tweet Posted September 3, 2012 By Carah Ong Greatest Hits from Democratic Conventions Since the Progressive Era FDR delivers his acceptance speech at the 1936 Democratic National Convention in Philadelphia. Public Domain. This week, I'll be blogging from Charlotte, North Carolina about the Democratic National Convention, as well as many of the side events and shadow conventions that receive less coverage from the mainstream media. Last week, Robert Saldin, who was blogging for RTT from Tampa, Florida for the Republican Convention, offered his top four Greatest Hits in the Modern History of Republican Conventions. In this post, I offer what I think are some of the Greatest Hits from Democratic Conventions since the Progressive Era. Be sure to stay tuned this week for my "Missives from a Shadow Delegate." William Jennings Bryan captured the party's nomination in 1896 with a speech in which he famously declared, "You shall not crucify mankind upon a cross of gold!" In the "Cross of Gold" speech, Bryan argued that the Democratic Party's focus on bi-metallism in its platform was justified because a gold standard alone could not solve the country's problems at the time, including debt, small business failure, and monopolies. According to Bryan, if silver was restored, "all other necessary reforms will be possible." He compared the situation to fights over the national bank, arguing: "What we need is an Andrew Jackson to stand, as Jackson stood, against the encroachments of organized wealth." In the speech, Bryan also connected the Democratic Party's tradition since Thomas Jefferson and Andrew Jackson against moneyed interests in favor of the little guy. Bryan favored a regulatory role for government in issuing money and called for banks to "go out of the governing business." In 1932, Franklin Delano Roosevelt was the first presidential candidate to deliver an acceptance speech at a party convention. When he learned he had secured the nomination, FDR flew from Albany to Chicago to deliver the speech at the convention. He said, "I know that this is breaking precedent to appear before you on this floor, but we're in a middle of a Great Depression, and I intend to break a lot of precedents this year and also as President." In his acceptance speech, FDR also told the delegates, "I pledge you, I pledge myself, to a new deal for the American people." The catch phrase became the basis for the sweeping political and economic changes FDR would enact as president. As I've noted previously on RTT, I also think FDR's acceptance speech in 1936 was important for defining a new understanding of government. In 1976, Barbara Jordan became the first black and the first woman to deliver the Democratic Party's keynote address. Instead of focusing on the nation's problems, Jordan advocated coming together as a "national community." "It's tough, difficult, not easy," Jordan told the delegates, "But a spirit of harmony will survive in America only if each of us remembers that we share a common destiny; if each of us remembers, when self-interest and bitterness seem to prevail, that we share a common destiny." Jordan was also the first female black senator elected to the Texas State Senate and she served as a U.S. Congresswoman from 1973-1978. Read the Miller Center's Oral History with Jordan here. Barack Obama's 2004 keynote address to the Democratic Convention in Boston made him a rising star in the party. In 2008, he became the first African American presidential candidate in the history of the two major political parties and accepted the nomination on the 45th anniversary of Martin Luther King, Jr.'s "I Have a Dream" speech. In the acceptance speech, Obama said both individual responsibility and mutual responsibility are "the essence of America's promise," and he called for a progressive agenda of change, while appealing to voters of all stripes. Which convention speech or speeches would you would to the list of "greatest hits"? Read more → Conventions 2012 Election Tweet Posted August 31, 2012 By Amber Lautigar Reichert Friday Feature: Candidate Romney Not Riding a Tiger Mitt and Ann Romney on Lake Winnipesaukee in New Hampshire. July, 2012. (AP Photo/Charles Dharapak) Is Romney ready for the tribulations of "riding the tiger" in the role of U.S. President? He seems to have a good grip on this wild ride. Stay tuned! Every Friday we'll highlight an interesting item from presidential history (or future!). Not Riding a Tiger Tweet Posted August 30, 2012 By Robert Saldin Shifting the Message or Shifting the Party? Fmr.Secretary of State Condoleezza Rice at Ronald Reagan Centennial Celebration in Prague. July 1, 2011. Photo by David Sedlecký. CC-SA. When it comes to messaging, this Republican National Convention has offered a jarring departure from the traditional GOP script. Typically, Republicans in convention have played to the longstanding partisan advantage they've enjoyed with the public on foreign affairs. But that theme has been virtually absent here in Tampa. In fact, for at least some of us in the audience, one welcome feature of Condoleezza Rice's widely heralded speech last night was its partial departure from what has become a rather repetitive message over the last two days. The former Secretary of State not only captivated a restless and distracted crowd, but actually offered remarks on something other than the economy. Yet as refreshing as it was to hear a new message emanating from the podium, it's actually the party's otherwise monotonous focus on the economy and the budget that tells us much more about Mitt Romney's Republican Party and that signals a major shift in GOP messaging. In the modern "infomercial" era of national conventions, the parties' most important task is to explain to millions of television viewers why they should vote Democrat or Republican. This objective produces what social scientists might call a "data rich" event in which dozens of party elites read carefully scripted messages to convey the party's message to the public and—just as importantly—to educate the assembled delegates about what, exactly, that message is. For scholars of parties and the party system, these messages are a potential treasure trove. They're easily accessible and comprise an unrivaled guide to the parties' public philosophies. Yet few scholars write about or pay much attention to—let alone show up at—party conventions. University of Wisconsin political scientists Byron Shafer, who has been attending both major party conventions since 1980, is a notable exception. Shafer's work emphasizes: "Every convention, no matter how well or badly managed, no matter how modestly or even thinly covered, does succeed in putting some messages—substantive arguments plus operational impressions—in front of a general public that, while viewership and ratings have declined, still registers in the multi-millions." Democrats and Republicans have traditionally offered divergent messages during their respective conventions. While Democrats have tended to focus on social welfare issues, Republicans have generally showcased foreign affairs. But—Rice aside—that's not we've seen here in Tampa. Foreign affairs haven't just played second fiddle to domestic issues, they've been almost entirely missing from the Republican message. An economically-oriented message would always be expected from budget hawks like Paul Ryan and Chris Christie. But this year's GOP message clearly goes deeper than that. The Republicans gathered here in Tampa have chosen to ignore foreign affairs and have gone all-in on the economy and their "grown-up" approach to the budget. The outcome of the election in November will likely tell us a lot about whether this year's shift in GOP messaging represents an enduring change in the party's presentation of itself to the American public or is merely a temporary diversion. Read more → Conventions 2012 Election Tweet Posted August 29, 2012 By Robert Saldin Barnburner or Instant Star?: Conversion Stories at Republican Conventions Representative Artur Davis. June 1, 2009. Photo by the Artur Davis Campaign. CC-SA. The old adage that "if you're not a liberal when you're 20, you have no heart, and if you're not a conservative by the time you're 40, you have no brain" is much more than a clever quip at Republican conventions. The convert story has a long history at these GOP gatherings and has come to hold a semi-official place on the program. Last night Artur Davis was the latest Democrat-turned-Republican to fill this slot. And while the prime-time TV audience may have missed it, inside the hall, Davis and his conversion story was the sleeper hit of the night that captivated the GOP faithful. Democratic conventions often have their own breakout performances, too. In 2004, for instance, Barack Obama's speech made him an instant star. In 2008, Montana Governor Brian Schweitzer offered up a classic red meat barnburner that upstaged the evening's headliners. But for Republicans, it's often the story of the disillusioned ex-Democrat that steals the show. This time-honored role at GOP conventions has no corollary at the Democratic counterpart (though Charlie Christ will try his hand at it next week in Charlotte). Part of the explanation for Republicans' adoration for the convert may lie in the relative lack of youthful energy and idealism that often fuels Democratic conventions and electoral campaigns. Lacking that rock star quality— which Davis summarized last night as "plywood Greek columns and artificial smoke…Hollywood stars and glamour,"—Republicans like to counter with, as Chris Christie put it during his show-closing Keynote Address, "tell[ing] us the hard truths we need to hear." Who better to hammer home this sober message for Republican true believers than a convert who used to revel in the Democrats' decadent culture of Valhalla excess? Read more → Conventions 2012 Election Tweet Posted August 28, 2012 By Carah Ong Enter RTT's Convention Bump Contest Since 1964, Gallup polling has shown that, on average, a presidential candidate will earn a five percentage point "bump" in polls following their party's convention. Of course, bumps for individual candidates vary and the sustainability of a post-convention bump depends upon circumstances and events that follow (e.g. financial crisis, poor debate performance, ect.). Furthermore, a convention bump doesn't necessarily mean election victory. As anticipation builds (at least among the party loyal) for the the Republican and Democratic National Conventions this week and next, we've decided to once again indulge your political junkie pleasures with a Convention Bump contest. Here are the rules. Enter the following information in the "Comments" to this post by 5 pm on Friday, August 31: Your prediction of how much of a bump Mitt Romney and Barack Obama will get following their party's respective conventions. Tell us how long the bump will last. You can, of course, predict no bump at all or a negative one (John Kerry, for example lost one percentage point following the Democratic convention in 2004). Winner(s) will receive a coveted Miller Center T-shirt and be featured in a blog post with nominal title of RTT's "Political Junkie of the Week." Read more → Conventions 2012 Election Tweet Posted August 28, 2012 By Robert Saldin Greatest Hits in the Modern History of Republican Conventions Ronald Reagan, "A Time for Choosing," October 27, 1964 As the Republican Party convenes in Tampa (albeit a day late), it's worth taking a moment to reflect on past gatherings. Here are my nominations for greatest hits of GOP conventions in the modern era: 1. Barry Goldwater, acceptance of 1964 presidential nomination A touchstone in the history of the Republican Party and the American conservative movement, the Arizona Senator's unapologetic speech rallied the faithful and exacerbated the GOP's internal ideological split. It also diverged from the standard acceptance speech formula. Goldwater's address pulled no punches and was devoid of the customary vapid overtures to one's political opponents. Instead, "Mr. Conservative" reminded the country that "Extremism in the defense of liberty is no vice…Moderation in the pursuit of justice is no virtue." 2. Pat Buchanan, 1992 Keynote Address In a now-infamous speech delivered after Buchanan's failed attempt to wrest the GOP nomination from sitting President George H.W. Bush, the former Reagan staffer alleged a "culture war" was on. The enemy was clear: "the malcontents" at the Democratic convention, "environmental extremists," the media, "radical feminism," and the Clinton agenda calling for "abortion on demand, a litmus test for the Supreme Court, homosexual rights, discrimination against religious schools, [and] women in combat." Many Republicans argued that Buchanan should never have been given such a prominent speaking role and were convinced his nationally televised remarks cost the Bush-Quayle ticket independent votes in November. 3. Zell Miller, 2004 Keynote Address The Georgia Senator filled the unofficial Disillusioned Democrat slot at the Republican Convention eight years ago. With the Iraq War in full swing, Miller's scathing address focused on foreign policy and his party's alleged abandonment of national security and capitulation to terrorists: "I can remember when Democrats believed it was the duty of America to fight for freedom over tyranny…Time after time in our history, in the face of great danger, Democrats and Republicans worked together to ensure that freedom would not falter. But not today. Motivated more by partisan politics than by national security, today's Democratic leaders see America as an occupier, not a liberator. And nothing makes this Marine madder than someone calling American troops occupiers rather than liberators!" 4. Sarah Palin, acceptance of 2008 vice-presidential nomination It's easy to forget that there were several days when John McCain's running mate selection appeared to be the stuff of political genius. The high point for the Alaska Governor—and perhaps for the 2008 McCain campaign—was her riveting convention speech accepting the vice-presidential nomination. Even those who didn't like the message were impressed with the delivery, and the Obama-Biden campaign was reportedly concerned that they'd been outmaneuvered by her surprise addition to the GOP ticket. Despite Code Pink protesters in the audience and a broken teleprompter, she didn't miss a beat. Of course, the wheels came off shortly after the Straight Talk Express pulled out of Minneapolis-St. Paul, and Palin never fully recovered from her interview with ABC's Charlie Gibson and her discussion of newspapers with Katie Couric. But for one night at least, Palin appeared to be just the game changer McCain was looking for. Honorable Mention: Ronald Reagan, "A Time for Choosing" aka "The Speech," 1964 Technically, the most legendary Republican convention speech wasn't a convention speech at all. It's a common misconception that this Reagan classic was delivered at the Republican National Convention in San Francisco. In fact, the Democrat-turned-Republican and future president actually gave his most famous address in a made-for-TV special in the campaign's closing days. And while "The Speech" may not have been enough to save Barry Goldwater from an historic landslide defeat at the hands of President Lyndon Johnson, it made Reagan a GOP star and became a manifesto for the conservative movement. Will there be any additions to the list this week? We'll know soon enough. The best bets: "Hurricane" Chris Christie's Keynote Address tonight and Paul Ryan's Vice Presidential acceptance speech tomorrow. Read more → Conventions 2012 Election Miller Center Resources Tweet Posted August 27, 2012 By Robert Saldin Do the Party Conventions Matter Anymore? Mitt Romney & Paul Ryan at a Rally in Manassas, VA. August 12, 2012. Photo by Monkeyz_uncle. CC-SA. This week Riding the Tiger will feature daily updates live from the Republican National Convention in Tampa, FL by Robert Saldin, Associate Professor of American Government and Politics at the University of Montana and a former Miller Center Fellow. TAMPA, FL -- A hurricane has prompted the Republicans to cancel the opening night of their convention…again. Four years ago, with Hurricane Gustav bearing down on the Gulf Coast, the GOP scrapped day one of their convention in Minneapolis-St. Paul. Not that anyone seemed to notice. Most first night speakers were simply reassigned to Tuesday. And with the star power backloaded into the final two nights, it wasn't clear that anything substantive was lost. This time is different only in that the Republicans find themselves in the storm's path. But with tonight now an official a no-go, it's hard to find anyone here in Tampa who is too upset by the cancellation, even—or, perhaps, especially—among the delegates. After all, the restaurants and bars are still open, and the hundreds of parties throughout the bay area are proceeding as planned. Many attendees are enjoying some time on the beach in between rain showers. And the television networks had never been planning to show up for the opening night. Of course, the mood could change considerably if evacuations are announced or additional nights of the convention are curtailed or cancelled. But as of now, the assembled partisans continue their party, now unburdened by tonight's session at the Tampa Bay Times Forum. Which raises the question: What's the point of these conventions in the 21st Century? Decades ago, party conventions played a substantive role in the presidential selection process, but now they're routinely derided as overly-scripted, phony, campaign commercials. Read more → Conventions 2012 Election Tweet 16 of 28 Pages ‹ First < 14 15 16 17 18 > Last ›


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Your independent guide to the best shows in New York
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Now showing, Closes 7 Feb 2015
Idina Menzel goes beyond anyone's idea of reasonable vocal or emotional limits, and basically blows the roof off of the theatre.
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Starting this weekend, tune in to "Broadway Names with Julie James" on SiriusXM ON Broadway for a special edition with Idina Menzel and the cast of If/Then, featuring LaChanze, Anthony Rapp and James Snyder.
The special will air on SiriusXM On Broadway, Channel 72:
In addition, Sirius will air the full If/Then cast recording during "Showtime" on Labor Day, Monday, September 1, at 11pm ET.
Idina Menzel originated the role of 'Maureen' in the hit Broadway musical RENT, a role which she reprised for the 2005 feature film adaptation of the musical. She received a Tony Award nomination in 1996 for her portrayal. In 2004, she won the Tony Award for Best Leading Actress in a Musical for originating the role of 'Elphaba' in the blockbuster Broadway musical WICKED. Menzel made her return to Broadway this year in If/Then and was nominated for a 2014 Tony Award for her performance.
Menzel is also known for her recurring role of 'Shelby Corcoran' on the musical comedy-drama television series GLEE, her part in the 2007 Disney movie ENCHANTED, and as the voice of 'Elsa' in the Disney animated film FROZEN, which is the highest-grossing animated film of all time, and in which she sang the Academy Award-winning song "Let It Go".
IF/THEN reunites Tom Kitt (music), Brian Yorkey (book and lyrics), and Michael Greif (director), the creative team behind the Pulitzer Prize and Tony Award-winning musical, Next to Normal. The company of If/Then features Menzel, LaChanze (Tony Award-winner for The Color Purple), Anthony Rapp (original cast of Rent), James Snyder(Cry-Baby), Jerry Dixon (tick, tick...Boom!, Once On This Island), Jenn Colella (Chaplin, High Fidelity), Jason Tam (A Chorus Line, Lysistrata Jones), Tamika Lawrence (Matilda), and Jackie Burns (Wicked).
Article reprinted with permission from www.BroadwayWorld.com
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Yoga in the Park was founded in 2009 and currently offers public and private yoga classes as well as special events. Yoga in the Park is a program of Children Families & Communities, a tax exempt non-profit organization.
The mission of Yoga in the Park is to provide a nature-based wellness program that is highly accessible to each individual in the community. This is yoga for all practice levels: We support the very beginner to the most seasoned yogi.
Let's amplify our connection! We can find bliss and balance through the practice of yoga. We can support each other through the practice of yoga. We can harmonize with our earth through the practice of yoga.
Yoga in the Park was honored "Best of Maine" 2013 by Down East Magazine. Check out our practice that is of the earth and out of this world at the following link: http://www.downeast.com/best-maine-self-2013/


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We've ridden, tested and evaluated dozens of the most promising bikes of 2012. From flyweight full-suspension 29ers to carbon downhill bikes and a handful of beautiful and revolutionary trail bikes, here are 12 of our favorites.
We caught our first glimpse of Intense's carbon Carbine a few weeks ago, but we finally got to spend some time on it in Park City. Although it's inspired by the company's aluminum Tracer 2, the Carbine is no carbon clone. The most significant difference is the geometry: Intense's trail bikes have traditionally run higher bottom brackets, but at 13.25 inches off the floor, the Carbine's is half an inch lower than the Tracer, and that makes a huge difference on the trail. Unlike the Blur LT, which also uses a VPP suspension, the Carbine isn't shockingly stiff, but it's stout enough, and the carbon frame does an excellent job of damping trail chatter. The frame and shock will cost about $2,580.