Global dietary calcium intake among adults: a systematic review

Osteoporosis International, Oct 2017

Low calcium intake may adversely affect bone health in adults. Recognizing the presence of low calcium intake is necessary to develop national strategies to optimize intake. To highlight regions where calcium intake should be improved, we systematically searched for the most representative national dietary calcium intake data in adults from the general population in all countries. We searched 13 electronic databases and requested data from domain experts. Studies were double-screened for eligibility. Data were extracted into a standard form. We developed an interactive global map, categorizing countries based on average calcium intake and summarized differences in intake based on sex, age, and socioeconomic status. Searches yielded 9780 abstracts. Across the 74 countries with data, average national dietary calcium intake ranges from 175 to 1233 mg/day. Many countries in Asia have average dietary calcium intake less than 500 mg/day. Countries in Africa and South America mostly have low calcium intake between about 400 and 700 mg/day. Only Northern European countries have national calcium intake greater than 1000 mg/day. Survey data for three quarters of available countries were not nationally representative. Average calcium intake is generally lower in women than men, but there are no clear patterns across countries regarding relative calcium intake by age, sex, or socioeconomic status. The global calcium map reveals that many countries have low average calcium intake. But recent, nationally representative data are mostly lacking. This review draws attention to regions where measures to increase calcium intake are likely to have skeletal benefits.

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Global dietary calcium intake among adults: a systematic review

Global dietary calcium intake among adults: a systematic review E. M. Balk 0 1 2 3 4 5 6 7 8 G. P. Adam 0 1 2 3 4 5 6 7 8 V. N. Langberg 0 1 2 3 4 5 6 7 8 A. Earley 0 1 2 3 4 5 6 7 8 P. Clark 0 1 2 3 4 5 6 7 8 P. R. Ebeling 0 1 2 3 4 5 6 7 8 A. Mithal 0 1 2 3 4 5 6 7 8 R. Rizzoli 0 1 2 3 4 5 6 7 8 C. A. F. Zerbini 0 1 2 3 4 5 6 7 8 D. D. Pierroz 0 1 2 3 4 5 6 7 8 B. Dawson-Hughes 0 1 2 3 4 5 6 7 8 0 Hospital Infantil de México Federico Gómez , Mexico City , Mexico 1 Evidera , 500 Totten Pond Rd, Waltham, MA , USA 2 Center for Evidence Synthesis in Health, Brown University School of Public Health , Providence, RI , USA 3 Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University , Boston, MA , USA 4 International Osteoporosis Foundation , Nyon , Switzerland 5 Centro Paulista de Investigação Clínica , Sao Paulo , Brazil 6 Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine , Geneva , Switzerland 7 Medanta Medicity , Sector 38, Gurgaon , India 8 School of Clinical Sciences, Monash University , Clayton , Australia Low calcium intake may adversely affect bone health in adults. Recognizing the presence of low calcium intake is necessary to develop national strategies to optimize intake. To highlight regions where calcium intake should be improved, we systematically searched for the most representative national dietary calcium intake data in adults from the general population in all countries. We searched 13 electronic databases and requested data from domain experts. Studies were double-screened for eligibility. Data were extracted into a standard form. We developed an interactive global map, categorizing countries based on average calcium intake and summarized differences in intake based on sex, age, and socioeconomic status. Searches yielded 9780 abstracts. Across the 74 countries with data, average national dietary calcium intake ranges from 175 to 1233 mg/day. Many countries in Asia have average dietary calcium intake less than 500 mg/day. Countries in Africa and South America mostly have low calcium intake between about 400 and 700 mg/day. Only Northern European countries have national calcium intake greater than 1000 mg/day. Survey data for three quarters of available countries were not nationally representative. Average calcium intake is generally lower in women than men, but there are no clear patterns across countries regarding relative calcium intake by age, sex, or socioeconomic status. The global calcium map reveals that many countries have low average calcium intake. But recent, nationally representative data are mostly lacking. This review draws attention to regions where measures to increase calcium intake are likely to have skeletal benefits. Bone health; Dietary calcium intake; Dietary surveys; Osteoporosis Introduction Calcium intake is one of the many factors affecting the development of peak bone mass and preservation of bone mass in adults. Calcium is an important component of bone, accounting for about 30 to 35% of its mass and much of its strength. The contribution of dietary calcium intake to bone mass is easiest to document during periods when bone mass is changing rapidly, that is, during adolescence when the skeleton gains up to 409 g per year in boys and 325 g per year in girls [ 1 ], and late in life when bone loss occurs at a rate of about 1% per year, resulting in calcium loss of approximately 15 g per year [ 2 ]. Low calcium intake in some populations may be adversely affecting the development of peak bone mass in adolescents and young adults and the retention of bone mass in older adults. Recognizing the presence of low calcium intake is a necessary first step in developing culturally appropriate strategies and policies to address the deficiency. The International Osteoporosis Foundation (IOF) took the initiative to describe dietary calcium intake in the general adult population in different countries based on a systematic review and to present the data on a global map. This study follows on a similar review and map of global vitamin D status conducted in 2011 (https://www.iofbonehealth.org/facts-and-statistics/ vitamin-d-studies-map) [ 3 ]. The aim of the current review was to find the most representative data for each country, regarding average dietary intake of calcium in general population adults. The available studies were used to populate a color-coded global map of average dietary calcium intake per country. Methods We used a systematic review approach to search for, select, and analyze available studies, following, to the extent possible, Institute of Medicine guidance [ 4 ]. The protocol was discussed and agreed upon with the Calcium Map Steering Committee of the IOF. The research team (EMB, GPA, VNL, AE) independently conducted the review. Preliminary findings were presented at the World Congress on Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases on March 24, 2017. Attendees were encouraged to in (...truncated)


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E. M. Balk, G. P. Adam, V. N. Langberg, A. Earley, P. Clark, P. R. Ebeling, A. Mithal, R. Rizzoli, C. A. F. Zerbini, D. D. Pierroz, B. Dawson-Hughes, for the International Osteoporosis Foundation Calcium Steering Committee. Global dietary calcium intake among adults: a systematic review, Osteoporosis International, 2017, pp. 1-10, DOI: 10.1007/s00198-017-4230-x