Trends in calcium supplementation, National Health and Nutrition Examination Survey (NHANES) 1999–2014

doi:10.1016/j.bone.2018.03.007

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Volume 111, June 2018, Pages 23-27

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Highlights

•
Excess calcium intake may not be entirely free from unintended health consequences
•
Supplemental calcium intake fluctuated between 1999 and 2014, increasing until 2007-2010 with subsequent decreases
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Few are consuming mean daily supplemental calcium at a level exceeding the tolerable upper limit
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Calcium supplement use at a level exceeding the estimated average requirement was not uncommon
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Prevalence of calcium supplement use beyond the estimated average requirement tended to be 3-4-fold greater in women than men

Abstract

Background

Long-term outcomes of supplemental calcium are inadequately understood. Recent research suggests that calcium from supplements may not be entirely free from unintended health consequences. Consequently, it is important to understand patterns and trends in use of calcium supplements.

Objective

To report trends in supplemental calcium intake between 1999 and 2014, using NHANES data, overall and stratified by sex, race/ethnicity and age.

Methods

A total of 42,038 adult NHANES participants were included in this analysis. For each survey period, we calculated the prevalence of calcium supplement use exceeding the Estimated Average Requirement (EAR) and Tolerable Upper Intake Levels (UL), and mean daily supplemental calcium dose among calcium-containing supplement users. Sample weights were applied. Linear regression was used to examine trends.

Results

Overall, the prevalence of calcium supplement use at a dose ≥EAR increased between 1999 and 2000 and 2013–2014, from 2.5% (95% CI: 1.9–3.3%) to 4.6% (3.8–5.5%). Use ≥EAR peaked in 2003–2004 at 6.7% (5.3–8.5%) (p-quadratic trend < 0.001). Mean supplemental calcium intake peaked in 2007–2008, thereafter decreasing (p-quadratic trend < 0.001). The overall prevalence of intake ≥UL from supplemental calcium in 2013–2014 was 0.4% (0.2–0.8%). Use of supplemental calcium ≥UL peaked during 2007–2008 at 1.2% (0.7–2.0%). In all time periods, supplemental calcium intake tended to be greater among women, non-Hispanic whites and adults >60 years.

Conclusions

We described the prevalence of U.S. adults consuming supplemental calcium ≥UL and ≥ EAR. While few were consuming supplemental calcium ≥UL, consumption ≥EAR was not uncommon, especially among women, non-Hispanic whites and older adults.

Section snippets

Background

Supplemental calcium use is common; [1] albeit controversial because it is unclear whether calcium supplementation prevents fractures [2,3] and there are concerns that it may potentially increase risk of kidney stones [[4], [5], [6]] and cardiovascular disease (CVD) [4,7]. Additionally, supplemental calcium can interact with certain medications, including thiazide diuretics, to increase the risk for hypercalcemia [8]. Calcium supplementation may also have gastrointestinal side effects, such as

Materials and methods

NHANES is a repeated cross-sectional survey, which samples non-institutionalized U.S. civilians through a stratified, multi-stage probability design (overall response range 69–80%) with over-representation of certain populations, notably Hispanics and non-Hispanic blacks. Starting in 2011–12, non-Hispanic Asians were also oversampled. The survey protocol is approved annually by the National Center for Health Statistics' Research Ethics Review Board and participants provided written informed

Results

The 42,038 NHANES participants were 50.0% female, 46.9% non-Hispanic white, and had a mean age of 50.6 y. Calcium supplement use ≥EAR tended to be 3–4-fold greater among women than men. For example, in 2013–2014, the prevalence of supplement use ≥EAR among women was 7.1% (5.8–8.7%) while in men it was 1.9% (1.3–2.9%). Notably, in 2013–2014, 10.4% of those aged 61–70 y and 8.5% of those >70 y consumed supplemental calcium ≥EAR. Overall, the prevalence of calcium supplement use at a dose ≥EAR

Conclusions

Using data from NHANES, weighted to be representative of the U.S. population, we found that about 5% of U.S. adults obtain a substantial proportion (i.e. ≥EAR) of their daily calcium requirements from supplemental calcium based on the most recent survey in 2013–2014. This was more common among women, non-Hispanic whites, and older adults.

Our findings are important for considering the population level effects of supplemental calcium intake. In observational settings, individuals who consume

Disclosures

There are no relevant potential conflicts of interest to report.

Acknowledgements

This research was supported by grants from the NIH National Heart, Lung, and Blood Institute [R01-HL103706, T32-HL-007779] and Office of Dietary Supplements [R01-HL103706-S1]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funders had no role in study design; in the collection, analysis, and interpretation of data; in writing the report; nor in the decision to submit the article for publication.

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Full Length ArticleTrends in calcium supplementation, National Health and Nutrition Examination Survey (NHANES) 1999–2014

Highlights

Abstract

Background

Objective

Methods

Results

Conclusions

Section snippets

Background

Materials and methods

Results

Conclusions

Disclosures

Acknowledgements

Am. J. Clin. Nutr.

Adv. Nutr.

Am. J. Clin. Nutr.

Adv. Nutr.

Am. J. Clin. Nutr.

Trends in dietary supplement use among US adults from 1999–2012

JAMA

Calcium intake and risk of fracture: systematic review

BMJ

Association between calcium or vitamin D supplementation and fracture incidence in community-dwelling older adults: a systematic review and meta-analysis

JAMA

Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC

Calcium intake and urinary stone disease

Transl. Androl. Urol.

Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis

BMJ

Calcium Fact Sheet for Health Professionals

Wardlaws Perspectives in Nutrition Updated with 2015 2020 Dietary Guidelines for Americans

Full Length Article
Trends in calcium supplementation, National Health and Nutrition Examination Survey (NHANES) 1999–2014