Research
Original Research
Calcium Intake in the United States from Dietary and Supplemental Sources across Adult Age Groups: New Estimates from the National Health and Nutrition Examination Survey 2003-2006

https://doi.org/10.1016/j.jada.2011.02.014Get rights and content

Abstract

Background

Adequate lifelong calcium intake is essential in optimizing bone health. Recent National Health and Nutrition Examination Survey data were used to quantify variation in calcium intake across adult age groups and to relate age-associated changes in calcium intake with energy intake. Additional goals were to assess differences in dietary calcium intake between supplemental calcium users and nonusers and to evaluate associations between age and calcium density in the diet.

Design

This cross-sectional analysis determined calcium and energy intake for National Health and Nutrition Examination Survey respondents during 2003-2006. Diet was assessed with 24-hour recall and supplement use via questionnaire. Trends in median intakes for dietary calcium, total calcium, and energy across age categories were assessed using survey analysis methods. Nutrient density was represented using calcium to energy intake ratios.

Results

The analyses included data from 9,475 adults. When compared to the 19- to 30-year age group, median dietary calcium intake was lower in the ≥81-year age group by 23% in men (P<0.001) and by 14% in women (P=0.003). These reductions coincided with 35% and 28% decreases, respectively, in median energy intake (P<0.001 for each sex). In contrast, the frequency of calcium supplement use increased (P<0.001) with age in both men and women. Yet, among female supplement users, the decline in median dietary calcium intake was greater than in nonusers (P=0.02). Calcium density in the diet significantly increased relative to age in men and women (P<0.001 for each sex); however, dietary and total calcium to energy ratios were insufficient to meet target ratios inferred by adequate intake standards after age 50 years.

Conclusions

Although supplemental calcium use and calcium density were highest in older age groups, they were not sufficient in meeting recommended levels. New approaches to increasing the frequency and level of calcium supplement use to enhance calcium density in diets may be necessary to reduce osteoporosis risk among older Americans.

Section snippets

Sample Population and Data Collection

NHANES is the only national survey that collects extensive health information from both face-to-face interviews and medical examinations. The data provide a cross-sectional picture of health and nutrition in the US population. The survey uses a complex, stratified, multistage, probability-cluster sampling design. A detailed description of the NHANES plans and procedures is provided elsewhere (24, 25).

The National Center for Health Statistics presently conducts NHANES in biennial cycles. The

Results

Participant characteristics are shown in Table 1. The total number of participants included in the analyses was 9,475. Median calcium intakes are presented in Table 2. Median dietary calcium intake in men decreased by 22.7% from the youngest to the oldest age group, from 942 mg/day to 728 mg/day (P<0.001). In women, it decreased by 14.1% (686 mg/day to 589 mg/day) from the youngest to oldest age group (P=0.003).

After age 30 years, energy intake for both men and women was consistently lower in

Discussion

Many studies present data describing calcium intake in the US population. Among them, this study is unique in that calcium intake from both dietary and supplemental sources were evaluated across adult age groups and compared to concomitant patterns of energy intake. In relating calcium and energy intake, calcium density within the diet was assessed and highlighted the fact that calcium density, as well as supplementation, plays a critical role in attainment of established AI levels.

Our data

Conclusions

Calcium plays a fundamental role in promoting bone health and forestalling osteoporosis. In light of evidence that energy intake declines with aging, calcium-dense foods and calcium supplements become vital factors in maintaining adequate calcium intake across the lifespan. Encouraging calcium supplementation is an established approach to addressing this issue in the clinical setting—one that needs additional emphasis to promote more frequent and sufficient supplementation in meeting AI levels.

K. M. Mangano is a certified dietitian nutritionist, Department of Nutritional Sciences, University of Connecticut, Storrs

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    K. M. Mangano is a certified dietitian nutritionist, Department of Nutritional Sciences, University of Connecticut, Storrs

    S. J. Walsh is an associate professor, School of Nursing, University of Connecticut, Storrs

    J. E. Kerstetter is a professor, Department of Allied Health Studies, University of Connecticut, Storrs

    K. L. Insogna is a professor of Internal Medicine Endocrinology, Department of Internal Medicine, Yale University, New Haven, CT

    A. M. Kenny is a professor, Center on Aging, University of Connecticut Health Center, Farmington

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