who are pregnant or lactating. For Thiamin and Niacin the PRIs are expressed as amounts per MJ of calories consumed. MJ = megajoule = 239 food calories. UL or Upper Limit Tolerable upper intake levels. ND ULs have not been determined. NE EARs have not been established. Supplementation In those who are otherwise healthy, there is little evidence that supplements have any benefits with respect to cancer or heart disease. Vitamin A and E supplements not only provide no health benefits for generally healthy individuals, but they may increase mortality, though the two large studies that support this conclusion included smokers for whom it was already known that beta-carotene supplements can be harmful. A 2018 meta-analysis found no evidence that intake of vitamin D or calcium for community-dwelling elderly people reduced bone fractures. Europe has regulations that define limits of vitamin (and mineral) dosages for their safe use as dietary supplements. Most vitamins that are sold as dietary supplements are not supposed to exceed a maximum daily dosage referred to as the tolerable upper intake level (UL or Upper Limit). Vitamin products above these regulatory limits are not considered supplements and should be registered as prescription or non-prescription (over-the-counter drugs) due to their potential side effects. The European Union, United States and Japan establish ULs. Dietary supplements often contain vitamins, but may also include other ingredients, such as minerals, herbs, and botanicals. Scientific evidence supports the benefits of dietary supplements for persons with certain health conditions. In some cases, vitamin supplements may have unwanted effects, especially if taken before surgery, with other dietary supplements or medicines, or if the person taking them has certain health conditions. They may also contain levels of vitamins many times higher, and in different forms, than one may ingest through food. Governmental regulation Most countries place dietary supplements in a special category under the general umbrella of foods, not drugs. As a result, the manufacturer, and not the government, has the responsibility of ensuring that its dietary supplement products are safe before they are marketed. Regulation of supplements varies widely by country. In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994. There is no FDA approval process for dietary supplements, and no requirement that manufacturers prove the safety or efficacy of supplements introduced before 1994. The Food and Drug Administration must rely on its Adverse