Dietary Calcium Intake Poor in Much of the World

Pam Harrison

November 08, 2017

People living in much of Asia consume critically low amounts of dietary calcium, with intake levels often less than 400 to 500 mg a day, a new systematic review from the International Osteoporosis Foundation (IOF) reveals.

 "In many parts of the world, there is lower [calcium] intake than there should be for good bone health," lead author Ethan Balk, MD, MPH, associate professor, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, said in a statement issued by IOF.

"While consumption is highest among adults in North America and Europe, it is alarmingly low in Asia and in some of the world's most populous countries, including China, India, and Indonesia," he added.

Calcium is a major building block of bone, accounting for between 30% and 35% of its mass and much of its strength, the authors indicate in their paper, published online October 12 in Osteoporosis International.

The impact of calcium intake is most significant during adolescence, when the skeleton gains bone mass, and during later life, when bone loss occurs at a rate of about 1% per year, resulting in calcium loss of approximately 15 g per year.

The concern is that in countries with suboptimal dietary calcium intake, men and women may be at increased risk of osteoporosis and subsequent fracture, they stress.

Indeed, future projections indicate that there may be as many as 6.26 million hip fractures in the year 2050, with steep increases already being reported in Beijing, China.

Lack of Good Data on Calcium Intake in Majority of World

For the review, researchers gathered data from studies that estimated dietary calcium intake data from the general adult population. These varied widely, including by how nationally representative they were and by their sample size. Nevertheless, there were enough eligible data for 74 countries out of almost 200, which revealed several notable regional trends, they note.

Global Calcium Intake [Source International Osteoporosis Foundation. Used with permission]

"Across the 74 countries with data, the best estimate of average dietary calcium intake among general population adults ranged from a low of 175 mg/day (Nepal) to 1233 mg/day (Iceland)," the investigators report.

Most countries in South, East, and Southeast Asia consume suboptimal amounts of calcium, at less than 400 mg a day, they note.

And many countries in Africa and South America don't do much better, averaging between 400 and 700 mg of calcium a day.

However, there were large variations in daily calcium intake across different nations in Latin America, from a low of 297 mg a day in Columbia to a high of 805 mg a day in Mexico, for example.

The only countries where the average daily calcium intake is high, at over 1000 mg a day, were all in Northern Europe.

Calcium Intake by Gender

The investigators also note that where average daily calcium intake was assessed by gender, intake levels were "generally lower" among women than among men.

And for reports where dietary calcium intake was assessed by age, they found that older people consume less calcium than younger people.

Notably, people living in the Asia-Pacific region in countries such as China, Malaysia, India, and South Korea have both very low levels of dietary calcium intake and poor vitamin D status.

In an earlier systematic review of vitamin D, the IOF found that mean serum levels among adults living in Asia-Pacific were between 25 and 49 nmol/L — levels that the Institute of Medicine suggests are insufficient, at least for people living in the United States.

It has previously been shown that suboptimal calcium intake is associated with lower bone-mineral density in older adults and that higher vitamin D levels do not compensate for poor calcium intake.

"This study draws attention to regions where calcium intake needs to be assessed and where measures to increase calcium intake would likely provide skeletal benefits for the population," senior author Bess Dawson-Hughes, MD, director, Bone Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, said in the IOF statement.

"This is a necessary first step in developing culturally appropriate strategies and policies to address this deficiency," she added.

An interactive online global map representing the study findings will be launched by IOF at the World Congress on Osteoporosis, Osteoarthritis, and Musculoskeletal Diseases in April 2018.

The study was funded by a grant to the International Osteoporosis Foundation from Pfizer Consumer Health. Dr Balk reports a grant from International Osteoporosis Foundation during the conduct of the study. Disclosures for the coauthors are listed in the paper.

Osteoporos Int. Published online October 12, 2017. Article

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