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Combined low dietary calcium intake (<800 mg/day; IOM RDA 1000-1200 mg/day age-dependent)...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-LIFESTYLE-LOW-CALCIUM-VIT-D-CRC-PREVENTION
TypeRed flag
Statusreviewed 2026-05-18 | pending_clinical_signoff
DiseasesDIS-CRC
SourcesSRC-NCCN-BCELL-2025 SRC-NCCN-COLON-2025

Red Flag Origin

DefinitionCombined low dietary calcium intake (<800 mg/day; IOM RDA 1000-1200 mg/day age-dependent) AND vitamin D deficiency (serum 25-hydroxy- vitamin D <30 nmol/L per IOM threshold, <50 nmol/L per Endocrine Society). WCRF/AICR Continuous Update Project rates dietary calcium as "probable" protective for colorectal cancer — meta-analyzed RR ~0.92 per 300 mg/day calcium intake. Vitamin D status (circulating 25-OH-D) is associated with CRC risk in observational cohorts (~30% incidence reduction in highest vs lowest quartile per IARC pooled analysis); causal RCT evidence is mixed (VITAL, ViDA trials did not show primary CRC-incidence reduction at population doses but signal for CRC mortality reduction with vitamin D supplementation). Mechanisms: calcium binds bile acids + fatty acids in colonic lumen reducing mucosal cytotoxicity; vitamin D regulates colonocyte proliferation + differentiation via VD...
Clinical directioninvestigate
Categoryother

Trigger Logic

{
  "all_of": [
    {
      "finding": "dietary_calcium_intake_lt_800mg_per_day",
      "value": true
    },
    {
      "finding": "serum_25oh_vitamin_d_lt_30nmol_per_l",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for combined low calcium intake + vitamin D deficiency. WCRF/AICR probable-evidence for calcium and CRC; IARC pooled signal for vitamin D status. RCT evidence for supplementation is mixed at population doses — counseling emphasizes adequate intake/repletion not pharmacologic dosing. Engine routes to PreventionPlan recommending dietary counseling + vitamin D repletion + CRC screening per USPSTF. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

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Indications