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      Risk of High Dietary Calcium for Arterial Calcification in Older Adults

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          Abstract

          Concern has recently arisen about the potential adverse effects of excessive calcium intakes, i.e., calcium loading from supplements, on arterial calcification and risks of cardiovascular diseases (CVD) in older adults. Published reports that high calcium intakes in free-living adults have relatively little or no beneficial impact on bone mineral density (BMD) and fracture rates suggest that current recommendations of calcium for adults may be set too high. Because even healthy kidneys have limited capability of eliminating excessive calcium in the diet, the likelihood of soft-tissue calcification may increase in older adults who take calcium supplements, particularly in those with age or disease-related reduction in renal function. The maintenance of BMD and bone health continues to be an important goal of adequate dietary calcium consumption, but eliminating potential risks of CVDs from excessive calcium intakes needs to be factored into policy recommendations for calcium by adults.

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          Estimation of total usual calcium and vitamin D intakes in the United States.

          Regan L. Bailey, Kevin Dodd, Joseph Goldman … (2010)
          Our objective in this study was to estimate calcium intakes from food, water, dietary supplements, and antacids for U.S. citizens aged >or=1 y using NHANES 2003-2006 data and the Dietary Reference Intake panel age groupings. Similar estimates were calculated for vitamin D intake from food and dietary supplements using NHANES 2005-2006. Diet was assessed with 2 24-h recalls; dietary supplement and antacid use were determined by questionnaire. The National Cancer Institute method was used to estimate usual nutrient intake from dietary sources. The mean daily nutrient intake from supplemental sources was added to the adjusted dietary intake estimates to produce total usual nutrient intakes for calcium and vitamin D. A total of 53% of the U.S. population reported using any dietary supplement (2003-2006), 43% used calcium (2003-2006), and 37% used vitamin D (2005-2006). For users, dietary supplements provided the adequate intake (AI) recommendation for calcium intake for approximately 12% of those >or=71 y. Males and females aged 1-3 y had the highest prevalence of meeting the AI from dietary and total calcium intakes. For total vitamin D intake, males and females >or=71, and females 14-18 y had the lowest prevalence of meeting the AI. Dietary supplement use is associated with higher prevalence of groups meeting the AI for calcium and vitamin D. Monitoring usual total nutrient intake is necessary to adequately characterize and evaluate the population's nutritional status and adherence to recommendations for nutrient intake.
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            Calcium balance in normal individuals and in patients with chronic kidney disease on low and high calcium diets

            David Spiegel, Kate Brady (2012)
            Calcium balance in chronic kidney disease is poorly understood since its deficiency is a stimulus for secondary hyperparathyroidism and consequent bone loss while calcium excess promotes extra-osseous calcifications. To help resolve this, we evaluated calcium balance in normal individuals and in patients with chronic kidney disease (CKD) on daily diets containing 800 and 2000 mg elemental calcium. Both normal individuals and patients with late stage 3 and stage 4 CKD were in slightly negative to neutral calcium balance on the 800 mg calcium diet. Normal individuals were in modest positive calcium balance on the 2000 mg diet while patients with CKD on the same diet were in marked positive calcium balance at least over the 9 days of study; and significantly greater than the normal individuals. Increased calcium intake significantly decreased 1,25 dihydroxy-vitamin D and intact parathyroid hormone levels but did not alter the serum calcium concentration. Thus, our finding have important implications for both preventing calcium deficiency and loading in individuals with late stage 3 and stage 4 CKD.
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              Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis.

              Vivian Robinson, Beverley Shea, Zulma Ortiz … (2002)
              To summarize controlled trials examining the effect of calcium on bone density and fractures in postmenopausal women. We searched MEDLINE and EMBASE up to 1998 and the Cochrane Controlled Register up to 2000, and we examined citations of relevant articles and proceedings of international meetings. We contacted osteoporosis investigators to identify additional studies, and primary authors for unpublished data. We included 15 trials (1806 patients) that randomized postmenopausal women to calcium supplementation or usual calcium intake in the diet and reported bone mineral density of the total body, vertebral spine, hip, or forearm, or recorded the number of fractures, and followed patients for at least 1 yr. For each trial, three independent reviewers assessed the methodological quality and extracted data. We found calcium to be more effective than placebo in reducing rates of bone loss after two or more years of treatment. The pooled difference in percentage change from baseline was 2.05% [95% confidence interval (CI) 0.24-3.86] for total body bone density, 1.66% (95% CI 0.92-2.39) for the lumbar spine, 1.64% (95% CI 0.70-2.57) for the hip, and 1.91% (95% CI 0.33-3.50) for the distal radius. The relative risk (RR) of fractures of the vertebrae was 0.77, with a wide CI (95% CI 0.54-1.09); the RR for nonvertebral fractures was 0.86 (95% CI 0.43-1.72). Calcium supplementation alone has a small positive effect on bone density. The data show a trend toward reduction in vertebral fractures, but do not meaningfully address the possible effect of calcium on reducing the incidence of nonvertebral fractures.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nutrients
                Journal ID (iso-abbrev): Nutrients
                Journal ID (publisher-id): nutrients
                Title: Nutrients
                Publisher: MDPI
                ISSN (Electronic): 2072-6643
                Publication date (Electronic): 30 September 2013
                Publication date Collection: October 2013
                Volume: 5
                Issue: 10
                Pages: 3964-3974
                Affiliations
                [1 ]Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
                [2 ]Division of Nephrology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA; E-Mail: Philip_klemmer@ 123456med.unc.edu
                Author notes
                [* ] Author to whom correspondence should be addressed; E-Mail: jjb_anderson@ 123456unc.edu ; Tel.: +919-966-5527; Fax: +919-966-7216.
                Article
                Publisher ID: nutrients-05-03964
                DOI: 10.3390/nu5103964
                PMC ID: 3820054
                PubMed ID: 24084054
                SO-VID: 34eb04ad-64f4-4af0-835a-17f98fc37519
                Copyright © © 2013 by the authors; licensee MDPI, Basel, Switzerland.
                License:

                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/).

                History
                Date received : 02 July 2013
                Date revision received : 23 August 2013
                Date accepted : 10 September 2013
                Categories
                Subject: Review

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: older adults,us dietary calcium intakes,calcium supplements,calcium balance,calcium homeostasis,vitamin d,bone mineral density,skeletal health,calcium loading,arterial calcification,cardiovascular disease,chronic renal disease,osteoporosis,recommended dietary allowance for calcium
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: older adults, us dietary calcium intakes, calcium supplements, calcium balance, calcium homeostasis, vitamin d, bone mineral density, skeletal health, calcium loading, arterial calcification, cardiovascular disease, chronic renal disease, osteoporosis, recommended dietary allowance for calcium

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