High or Low Calcium Intake Increases Cardiovascular Disease Risks in Older Patients With Type 2 Diabetes

Jui-Hua Huang; Leih-Ching Tsai; Yu-Chen Chang; Fu-Chou Cheng

Cardiovasc Diabetol. 2014;13(120)

Conclusions

High or low calcium intake was found to increase CVD risks in older patients with type 2 diabetes. A balanced dietary Mg and Ca intake is highly recommended, which could be a key in reducing inflammatory responses and CVD risks. Our data suggest that (1) consuming "moderate" amount of 402–600 mg Ca/day (approximately 67%–100% of Taiwan RDA for Ca), (2) consuming adequate amount of Mg (or meeting RDA for Mg for healthy individuals above 65 years of age), and (3) maintaining a Ca:Mg intake ratio of 2.0–2.5 are important for reducing CVD risks in older patients with diabetes.

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Table 1. Characteristics of older adults with type 2 diabetes by gender
Variables	Total (n = 197)	Male (n = 90)	Female (n = 107)	P ⁴
Age (y)	72.1 ± 5.3	72.2 ± 5.4	72.1 ± 5.3	0.935
Diabetes medication
Oral hypoglycemic drug	138 (70.1)	65 (72.2)	73 (68.2)	0.542
Insulin and oral hypoglycemic drug	69 (29.9)	25 (27.6)	34 (31.8)
Glycated hemoglobin (%)	7.3 ± 1.3	7.4 ± 1.3	7.3 ± 1.3	0.534
Estimated GFR¹ (ml/min)	71.2 ± 19.1	70.3 ± 19.1	71.9 ± 19.1	0.541
Body mass index (kg/m²)	25.3 ± 3.7	24.9 ± 3.4	25.6 ± 4.0	0.176
High-sensitivity CRP¹ (mg/L)
<1 low cardiovascular risk	57 (28.9)	27 (30.0)	30 (28.0)	0.169
1–3 moderate cardiovascular risk	105 (53.3)	52 (57.8)	53 (49.5)
>3 high cardiovascular risk	35 (17.8)	11 (12.2)	24 (22.4)
Dietary intake
Total energy intake (kcal/day)	1583.7 ± 414.3	1765.3 ± 434.5	1424.8 ± 322.1	<0.001
Carbohydrate intake (% of energy)	60.9 ± 8.5	59.5 ± 8.5	62.1 ± 8.3	0.027
Protein intake (% of energy)	12.4 ± 2.6	12.5 ± 2.4	12.3 ± 2.8	0.464
Fat intake (% of energy)	26.7 ± 7.3	28.2 ± 7.5	25.3 ± 6.9	0.004
Calcium (mg/day)	556.9 ± 385.3	557.9 ± 319.1	556.0 ± 436.5	0.972
<AI	172 (87.3)	82 (91.1)	90 (84.1)	0.142
<a previous RDA^1,2	120 (60.9)	53 (58.9)	67 (62.6)	0.593
Magnesium (mg/day)	218.4 ± 102.4	252.5 ± 112.8	188.6 ± 81.8	<0.001
<RDA³	172 (87.3)	72 (80.0)	100 (93.5)	0.005

¹GFR: glomerular filtration rate, CRP: C-reactive protein, AI: adequate intake, RDA: recommended dietary allowance, EAR: estimated average requirement.
²A previous Taiwan RDA for Ca for healthy individuals above 65 years of age is 600 mg/day. Current Taiwan AI of Ca for healthy individuals above 65 years of age is 1000 mg/day.
³Taiwan RDA for Mg for health individuals above 65 years of age is 350–360 mg/day for men and 300–310 mg/day for women.
⁴A p value <0.05 was considered statistically significant. Continuous data are presented as mean ± SD. Categorical data are presented as number (n) and percent (%).

Table 2. Relationships of dietary Ca:Mg intake ratio and markers of inflammation and CVD risk in older patients with diabetes
Variables	Quintiles of dietary Ca:Mg ratio					p ⁴
Variables	≤1.3 (n = 40)	1.4–1.9 (n = 39)	2.0–2.5 (n = 42)	2.6–3.6 (n = 38)	>3.6 (n = 38)	p ⁴
Dietary Ca and Mg intake¹
Calcium intake (mg/day)*	212.9 ± 179	312.8 ± 158.2	555.3 ± 219.0	700.6 ± 261.1	1060 ± 396.5	<0.001
Magnesium intake (mg/day)	223.9 ± 138.6	204.3 ± 96.9	251.6 ± 104.0	231.1 ± 90.7	193.7 ± 64.8	0.099
Markers of inflammation and cardiovascular risk²
High-sensitivity CRP (mg/L)^†	1.8 ± 0.3	1.9 ± 0.4	1.2 ± 0.4	1.8 ± 0.4	2.7 ± 0.4	0.013
White blood cell (10⁹ cells/L)	6.6 ± 0.3	6.2 ± 0.3	5.9 ± 0.3	6.8 ± 0.4	6.4 ± 0.4	0.200
Platelet (10³/μL)	227.5 ± 11.0	203.4 ± 11.2	205.7 ± 11.3	235.5 ± 11.7	224.3 ± 11.7	0.046
Red blood cell distribution width (%)^†	13.5 ± 0.2	13.6 ± 0.2	13.1 ± 0.2	13.7 ± 0.2	13.8 ± 0.2	0.032
Number of high inflammatory markers³
0	10(25.0)	17(43.6)	21(50.0)	12(31.6)	7(18.4)	0.002
1	14(35.0)	7(17.9)	18(42.9)	10(26.3)	16(42.1)
≥2	16(40.0)	15(38.5)	3(7.1)	16(42.1)	15(39.5)

¹The comparisons of the means were analyzed by one-way ANOVA. *indicates significant difference in Ca intake between the subgroup with a ratio of 2.0–2.5 and those with ratios of ≤1.3, 1.4–1.9, and >3.6 by Scheffe's multiple comparisons test.
²The analyses were adjusted for sex, age, glycated hemoglobin, BMI, physical activity levels, smoking, alcohol consumption, and total energy, carbohydrate, protein, and fat intake. The data are adjusted mean ± standard error (SE). ^†indicates significant difference in CRP and red blood cell distribution width between the subgroup with a ratio of 2.0–2.5 and the one with a ratio of >3.6 by Bonferroni's multiple comparisons test.
³Categorical variables were analyzed by chi-square test. The data are presented as number (n) and percent (%). The definition of high levels of the following four inflammatory markers: CRP >3 (mg/L), white blood cell >6.5 (10³/mm³), platelet >227.0 (10³/μL), and red blood cell distribution width >13.6 (%).
⁴A p value of <0.05 was considered statistically significant.

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