12 January - 20 June 2016

Calcium intake and mortality in women

20 Feb 13

A study published in the British Medical Journal by Michaelsson et al. has investigated the association between long term intake of dietary and supplemental calcium and death from all causes and cardiovascular disease.  The scientists note that insufficient calcium intake may lead to secondary hyperparathyroidism which is associated with higher mortality.  In the US more than 60% of middle aged and older women use calcium supplements, however some studies have indicated that supplemental use can lead to a higher risk of both ischemic heart disease and stroke.  Michaelsson et al. analysed data from 61433 women involved in the Swedish mammography cohort followed up for a median of 19 years.    Diet was assessed by a food frequency questionnaires, and primary outcomes from registry data. Of the participants, 11944 women died from all causes, 3862 from cause specific cardiovascular disease, 1932 from ischaemic heart disease and 1100 from stroke. The mean intake of calcium was 572mg/day (the equivalent of five slices of cheese) in the lowest quartile and 2137mg/day in the highest quartile.   The team observed highest rates of all-cause, cardiovascular and heart disease in those with a dietary calcium intake higher than 1400mg/day.  They also report higher death rates among women with an intake below 600mg/day. Women who had a higher dietary intake of calcium exceeding 1400mg/day and also used supplements had a higher death rate compared to those not taking supplements. Women with a high dietary calcium intake (>1400 mg/day) were more than twice as likely to die compared with women with a 600-999mg/day calcium intake.  Michaelsson et al. discuss a number of explanations for their findings indicating that diets very low or very high in calcium can override normal homeostatic control causing changes in blood levels of calcium or calciotropic hormones.  They report that meals high in calcium can reduce calcitriol, the active vitamin D metabolite which increases fibroblast growth factor 23 associated with an increased risk of cardiovascular events and all cause mortality. 

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