Calcium

1. Lin YC, Lyle RM, McCabe LD, McCabe GP, Weaver CM, Teegarden D. Dairy Calcium is Related to Changes in Body Composition During a Two-year Exercise Intervention in Young Women. J Am Coll Nutr. 2000 Nov-Dec;19(6):754-60.

Objective: Relationships between micronutrients and dairy product intake and changes in body weight and composition over two years were investigated. DESIGN: Two year prospective non-concurrent analysis of the effect of calcium intake on changes in body composition during a two year exercise intervention. SUBJECTS: 54 normal weight young women, 18 to 31 years of age.

Measures of Outcome: Mean intakes of nutrients of interest were determined from three-day diet records completed at baseline and every six months for two years. The change in total body weight and body composition (assessed by dual x-ray absorptiometry) from baseline to two years was also determined. RESULTS: Total calcium/kilocalories and vitamin A together predicted (negatively and positively, respectively) changes in body weight (R2 = 0.19) and body fat (R2 = 0.27). Further, there was an interaction of calcium and energy intake in predicting changes in body weight, such that, only at lower energy intakes, calcium intake (not adjusted for energy) predicted changes in body weight.

Conclusions: Regardless of exercise group assignment, calcium adjusted for energy intake had a negative relationship and vitamin A intake a positive relationship with two year changes in total body weight and body fat in young women aged 18 to 31 years. Thus, subjects with high calcium intake, corrected by total energy intake, and lower vitamin A intake gained less weight and body fat over two years in this randomized exercise intervention trial.

2. Davies KM, Heaney RP, Recker RR, Lappe JM, Barger-Lux MJ, Rafferty K, Hinders S. Calcium Intake and Body Weight. J Clin Endocrinol Metab. 2000 Dec;85(12):4635-8.

Five clinical studies of calcium intake, designed with a primary skeletal end point, were reevaluated to explore associations between calcium intake and body weight. All subjects were women, clustered in three main age groups: 3rd, 5th, and 8th decades. Total sample size was 780. Four of the studies were observational; two were cross-sectional, in which body mass index was regressed against entry level calcium intake; and two were longitudinal, in which change in weight over time was regressed against calcium intake. One study was a double-blind, placebo-controlled, randomized trial of calcium supplementation, in which change in weight during the course of study was evaluated as a function of treatment status. Significant negative associations between calcium intake and weight were found for all three age groups, and the odds ratio for being overweight (body mass index, >26) was 2.25 for young women in the lower half of the calcium intakes of their respective study groups (P: < 0.02). Relative to placebo, the calcium-treated subjects in the controlled trial exhibited a significant weight loss across nearly 4 yr of observation. Estimates of the relationship indicate that a 1000-mg calcium intake difference is associated with an 8-kg difference in mean body weight and that calcium intake explains approximately 3% of the variance in body weight.

3. Heaney RP. Calcium, Dairy Products and Osteoporosis. J Am Coll Nutr. 2000 Apr;19(2 Suppl):83S-99S.

Osteoporosis is a multifactorial disorder in which nutrition plays a role but does not account for the totality of the problem. 139 papers published since 1975 and describing studies of the relationship of calcium intake and bone health are briefly analyzed. Of 52 investigator-controlled calcium intervention studies, all but two showed better bone balance at high intakes, or greater bone gain during growth, or reduced bone loss in the elderly, or reduced fracture risk. This evidence firmly establishes that high calcium intakes promote bone health. Additionally, three-fourths of 86 observational studies were also positive, indicating that the causal link established in investigator-controlled trials can be found in free-living subjects as well. The principal reason for failure to find an association in observational studies is the weakness of the methods available for estimating long-term calcium intake. While most of the investigator-controlled studies used calcium supplements, six used dairy sources of calcium; all were positive. Most of the observational studies were based on dairy calcium also, since at the time the studies were done, higher calcium intakes meant higher dairy intakes. All studies evaluating the issue reported substantial augmentation of the osteoprotective effect of estrogen by high calcium intakes. Discussion is provided in regard to the multifactorial complexity of osteoporotic response to interventions and to the perturbing effect in controlled trials of the bone remodeling transient, as well as about how inferences can validly be drawn from the various study types represented in this compilation.

4. Baron JA, Beach M, Mandel JS, van Stolk RU, Haile RW, Sandler RS, Rothstein R, Summers RW. Calcium Supplements and Colorectal Adenomas. Ann N Y Acad Sci. 1999;889:138-45.

Experimental and observational findings suggest that calcium intake may protect against colorectal neoplasia. To investigate this hypothesis, we conducted a randomized, double-blind trial of colorectal adenoma recurrence. Nine hundred thirty patients with a recent history of colorectal adenomas were randomly given calcium carbonate (3 gm daily; 1200 mg elemental calcium) or placebo, with follow-up colonoscopies one and four years after the qualifying examination. The main analysis focused on new adenomas found after the first follow-up endoscopy, up to (and including) the second follow-up examination. Risk ratios of at least one recurrent adenoma and ratios of the average numbers of adenomas were calculated as measures of calcium effect. There was a lower risk of recurrent adenomas in subjects assigned calcium. Eight hundred thirty-two patients had two follow-up examinations and were included in the main analysis; the adjusted risk ratio of one or more adenomas was 0.81 (95% CI 0.67 to 0.99); the adjusted ratio of the average numbers of adenomas was 0.76 (95% CI 0.60 to 0.96). Among subjects who had at least one follow-up colonoscopy, the adjusted risk ratio of one or more recurrent adenomas was 0.85 (95% CI 0.74 to 0.98). The effect of calcium seemed independent of initial dietary fat and calcium intake. No toxicity was associated with supplementation. These findings indicate that calcium supplementation has a modest protective effect against colorectal adenomas, precursors of most colorectal cancers.

5. Kamel HK. Male Osteoporosis: New Trends in Diagnosis and Therapy. Drugs Aging. 2005;22(9):741-8.

Osteoporosis is a common condition in men affecting approximately 2 million males in the US. Compared with women, osteoporosis develops later in life and the incidence of osteoporosis-related fractures is lower in men. The morbidity and mortality associated with osteoporotic fractures are much greater in men compared with women, and secondary causes of osteoporosis are more frequently (in approximately 50% of cases) identified in men compared with women with osteoporosis. Excessive alcohol consumption, glucocorticoid excess and hypogonadism are the most commonly identified causes. Primary osteoporosis in men has been linked to changes in sex steroid secretion, the growth hormone-insulin-like growth factor-1 (GH-IGF-1) axis and the vitamin D-parathyroid hormone (PTH) 25-hydroxyvitamin D [25(OH)D]-PTH system. Diagnosing osteoporosis in men is complicated by an ongoing debate on whether to use sex-specific reference values for bone mineral density (BMD) or female reference values. The International Society for Clinical Densitometry recommended using a T score of -2.5 or less of male reference values to diagnose osteoporosis in men who are > or =65 years of age. However, this definition is yet to be validated in terms of fracture incidence and prevalence. Ensuring adequate calcium and vitamin D intake is the cornerstone of any regimen aimed at preventing or treating osteoporosis in men. Bisphosphonates are currently the therapy of choice for treatment of male osteoporosis. A short course of parathyroid hormone (1-34) [teriparatide] may be indicated for men with very low BMD or in those in whom bisphosphonate therapy is unsuccessful. The use of testosterone-replacement therapy for the prevention and treatment of male osteoporosis remains controversial but likely to benefit osteoporotic men with evident hypogonadism.

6. Hildebolt CF. J Periodontol. Effect of vitamin D and calcium on periodontitis. 2005 Sep;76(9):1576-87.

The anthropological record indicates that we are exposed to considerably less ultraviolet radiation (required for the synthesis of vitamin D) and consume considerably less calcium than did our early ancestors. Most U.S.citizens have calcium intakes and serum levels of vitamin D far below recommended values. This is despite there having been extensive evidence that optimal calcium and vitamin D intakes not only benefit our postcranial bone health but also have many other health benefits. Numerous articles indicate that vitamin D and calcium deficiencies result in bone loss and increased inflammation, which are well recognized symptoms of periodontal disease. For more than 40 years, investigators have suggested that calcium intake may be associated with alveolar bone resorption, and more recently there have been a number of studies in which investigators have suggested that calcium and vitamin D may benefit periodontal health, and it has been suggested that calcium deficiency may be a risk factor for periodontal disease. There has not, however, been a vitamin-D-calcium-periodontitis clinical trial in which randomization and masking were carefully controlled, the periodontal disease status of patients known, periodontal disease measures were the primary outcomes, and levels of intake optimized to produce maximal effects. Such research might demonstrate that calcium and vitamin D are important adjuncts to standard treatments for preventing and treating periodontal disease.

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