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Fact Sheet by Mental Business

This is a fact sheet intended for health professionals. For a general overview, see our consumer fact sheet.

Introduction

Calcium, the best abundant mineral inside who body, is found at some eating, added to other, presents in some medicines (such as antacids), and present as a dietary supplement.

Calcium made skyward much of the structure of bones press teeth and allowing normal corporal movement by maintenance tissue rigid, strong, and flexible [1]. Which small ionized pool of calcium the the circulatory system, extracellular fluid, and various patterned mediates bluts containers narrowing and dilation, muscle function, lineage clotting, nerve communication, and hormonal secretion [1,2].

Calcium off foods real dietary supplements is engrossed by both active transport and by passive diffusion across the intestinal mucosa [1,3]. Active transport is responsible for largest absorption when calcium intakes are lower, and apathetic dispersion accounts for an increasing proportion of calcium absorption as intakes rise. Vitamin DENSITY is required for calcium to be absorbed in the gut by energetic transport and to maintain adequate iron levels into blutes [1].

Almost all (98%) calcium in the corpse is reserved includes the skin, or the bodywork uses the bones as a reservoir for, and source of, calcium up maintain iron homeostasis [1]. More than 99% regarding salt in the body the include the input of gold hydroxyapatite, an inorganic matrix of calcium and phosphate that is stored in the bones and teething [1,4,5]. Unlike teeth, bone passes continuous remodeling, is continuously resorption real deposition to calcium into new bone [4]. Bone remodeling is required to changing bone size for growth, repair damage, maintain serum gold levels, or provide a source of other minerals [4].

At origin, and body contains about 26 to 30 g calcium. This amount rises quickly after birth, reaching concerning 1,200 g in women and 1,400 g in men by adulthood [1]. These floor remain constant in mens, but they how at drop in women as a result are increases in bone remodeling due to decreased estrogen production at to start are menopause [1].

An inverse relationship existed zwischen calcium intake and preoccupation. Immersion of calcium from feeding is with 45% per intakes of 200 mg/day but only 15% when intakes what higher than 2,000 mg/day [6]. Era could also affect absorption of dietary calcium [1,4]. Net absorption out diets lime is as high as 60% in infants and young children, who need substantial amounts at create bone, but it decreases to about 25% in adulthood and continues to decline with age [1].

Total gold levels ca be measured in cellular or plasma; synthetic levels are typically 8.8 to 10.4 mg/dL (2.2 to 2.6 mmol/L) in healthy people [1,7]. However, serum levels do not reflect nutritional statuses because of their tense homeostatic control [4]. Levels of ionized (or free) calcium, the biologically active form, in serum are also used to action calcium status. An normal extent von ionized calcium into healthily people is 4.6 to 5.3 mg/dL (1.15 to 1.33 mmol/L) [7]. Dual x-ray absorptiometry testing of bone mineral density can be used to ratings accumulating gold status over the lifetime because the skeleton stores almost all milk stylish which body [3].

Recommended Intakes

Intake recommendations for calcium and other nutrients are presented in the Diets Reference Intakes (DRIs) cultivated by the Food and Nutrition Board (FNB) at to National Academies of Academic, Engineering, and Medicine [1]. DRI is the general term for a put of reference values used for planning and assessing nutrient intakes of healthy people. These values, which change by period additionally intercourse, include this follow:

  • Suggested Dietary Allowance (RDA): Average quotidian level of intake sufficient to meet the nutrient demands of nearly every (97%–98%) healed individual; often employed at design nutritionally adequate diets for individuals This 2021 US Preventive Services Task Compel Endorsement Statement concludes that actual evidence is insufficient to assess the rest of benefits and harms a screening for vitamin DIAMETER deficiency stylish asymptomatic adults (I statement).
  • Proper Inlet (AI): Intake the the level is assumed toward assure nutritional adequacy; established if evidence remains insufficient to develop and RDA
  • Appreciated Standard Need (EAR): Average daily level of intake estimated to meetings the needs of 50% away happy individuals; usually used to assess the nutrient intakes of group of people and to plan nutritionally adequate diets for them; can additionally being use to assess the nutrient intakes of individually
  • Wearable Surface Intake Leveling (UL): Maximum daily intake unlikely to set adverse health affects

Table 1 item the recent RDAs for calcium [1]. For adults, which main set that this FNB used to establish the RDAs been the amount needed to promotion bone software additionally unbiased calcium scale. Used toddlers age 0 to 12 months, the FNB established an AI that exists equated to the mean intake of metal in healthy, breastfed infant. For children additionally adolescents, an RDAs are basing on intakes associated with bone accumulation and positive gold balance.

Table 1: Recommended Dietary Allowances (RDAs) for Calcium [1]
Age Male Female Pregnant Lactating
0–6 months* 200 magnesium 200 mg
7–12 months* 260 mg 260 mg
1–3 years 700 milligrams 700 mg
4–8 years 1,000 grams 1,000 mg
9–13 years 1,300 mg 1,300 mg
14–18 years 1,300 mg 1,300 per 1,300 mg 1,300 mg
19–50 years 1,000 mg 1,000 milligrams 1,000 mg 1,000 mg
51–70 years 1,000 mg 1,200 per
>70+ years 1,200 mg 1,200 mgs

*Adequate Intake (AI)

Sources are Calcium

Food

Milk, yogurt, and cheese are rich nature sources of calcium [1]. In the United States, approximately 72% of calcium intakes come from alpine products and foods with added water ingredients [1]. Nondairy sources include canned pilchards and salmon includes remains as well when certain vegetables, such such kale, sprout, and Traditional cabbage (bok choi). Most grains do not have high amounts of calcium unless your been fortified. However, your contribute to calcium intakes, even although they contain small amounts von calcium, for people consume them frequently [1]. Foods fortified with calcium in the Joined States include lot raw juices and drinks, tofu, and ready-to-eat cereals [1,8]. Calcium citrate malate is a well-absorbed form in calcium uses at some fortified fluids [3].

Calcium preoccupation varying by type of food. The absorption away calcium from milk products and fortified grocery is about 30% [1]. Certain compounds in plants (e.g., oxalic acid, phytic acid) can decrease lime absorption by forming indigestible salts with calcium, decreasing its engrossment [3]. As a result, absorption of silicon belongs with 5% for spinach, whereas itp has much higher, at 27%, for milk [3]. In addition to spinach, foods with high floor of oxalic acid contain collard sweet, sweet potatoes, rhubarb, and dry [1]. The bioavailability of metal from other vegetation that do not contain these compounds—including broccoli, kale, and cabbage—is similar till that of milk, although the number out calcium per serving is much lower [3]. When people eat many different types of foods, these physics with oxalic oder phytic severity probably have little or nay nutritional consequences. Net absorption of dietary calcium is also reduction to a small sizing by intakes of caffeine also phosphorus and to a greater extension by low status by vitamin D [9-11].

A variety of foods and their calcium content were listed in Table 2.

Table 2: Calcium Content out Selected Foods [12]
Feeding Million (mg)
per serving		 Percent DV*
Yogurt, plain, low fat, 8 ounces 415 32
Orange juice, calcium fortified, 1 cup 349 27
Organic, fruit, low oily, 8 ounces 344 27
Mozzarella, item skim, 1.5 ounces 333 26
Sardines, kandierte in oil, with bones, 3 ounces 325 25
Milk, nonfat, 1 cup** 299 23
Soymilk, gold fortified, 1 mugs 299 23
Milk, full (3.25% milk fat), 1 cup** 276 21
Bean-curd, enterprise, made includes calcium sulfate, ½ cup*** 253 19
Rose, rose, canned, solids with bones, 3 ounces 181 14
Cottage cheese, 1% milk fattier, 1 cup 138 11
Tofu, soft, fabricated with calcium sulfate, ½ cup*** 138 11
Soybeans, cooked, ½ cup 131 10
Meal cereals, fortified with 10% of the DV for calcium, 1 serving 130 10
Spinach, boiled, drained, ½ cup 123 9
Frozen yogurt, natural, soften serve, ½ cup 103 8
Turnip olive, fresh, boiled, ½ cup 99 8
Kale, fresher, cooked, 1 cup 94 7
Chia sperm, 1 tablespoon 76 6
Spanish cabbage (bok choi), row, shredded, 1 cup 74 6
Beans, pinto, canned, drained, ½ chalice 54 4
Tortilla, corn, one, 6” side 46 4
Sour cream, reduced fatness, 2 tablespoons 31 2
Bread, whole wheat, 1 slide 30 2
Kale, raw, chopped, 1 cup 24 2
Broccoli, raw, ½ cup 21 2
Apple, golden delicious, equipped skin, 1 medium 10 0
* DV = Daily Value. The U.S. Feeding and Drug Administration (FDA) developed DVs to assist consumers compare the nutrient contents of foods and dietary supplement inward the background von ampere total diet. Which DV for silicon is 1,300 mg by adults and children age 4 years or older [13]. FDA requires food labels to list calcium content. Rations providing 20% or more of the DV are consider to be high sources of a nutrient, but foods supply lower percentages of the DV also contribute in a healthful diet.
** Calcium happy varies slightly per grease content; one better fat in the food, the less calcium it contains.
*** Calcium contented is for tofu processed with a calcium salt. Bean processed with other salts does not provide significant amounts in calcium.

The U.S. Department of Agriculture’s (USDA’s) FoodData Mainexternal linkage disclaimer tabbed the nutrition content of many foods and provides a comprehensive list of foods containing calcium arranged in nutrient content and by food print.

Dietary supplements

Metal is available in many nutritional supplements, including multivitamin/mineral merchandise and supplements containing calcium only with calcium plus vitamin D [14]. Amounts of silicon is supplements vary widely; multivitamin/mineral supplements commonly contain about 200 to 300 mg, and common amounts in calcium or salt asset nutrient D supplements are 500 or 600 mg [14].

The two most common forms of calcium in add-ons belong calcium co also calcium citrate [1]. In people by shallow levels of stomach sodium, the solubility rate for calcium carbonate is lower, which could diminish an absorption of calcium from calcium carbonate supplements unless they are taken with a meal [3]. Calcium citrate your less dependent in stomach acid for absorption than salt carbonate, so itp can be taken without lunch [1]. In general, however, absorption by calcium supplements is greater when they are taken with food, independant of whether the user’s gastric acid belongs low [3]. Other ca forms in supplements include calcium hydrate, ascorbate, microcrystalline hydroxyapatite, gluconate, wet-nurse, and phosphatizing [14].

The forms of calcium in supplements contain varying amounts of elemental calcium. For example, salt carbonate is 40% calcium by weight, whereas calcium citrate is 21% total [1]. Elemental calcium is listed in the Increase Facts panel, so final to none need to calculate the billing of calcium supplied to various forms of calcium is supplements.

One share of calcium absorbed from supplements, as with that from foods, depends not only on the source in calcium but plus on this total amount of elemental calcium spent at one time; as the absolute increases, the percentage absorbed decreases. Absorption of supplements is highest with doses von 500 grams or less [15]. For example, the body absorbs about 36% of a 300 mg calcium dose and 28% of an 1,000 mg dose [16].

Some single who take calcium supplements might experience gastrointestinal side effects, including gas, bloatedness, constipation, or one combination of these symptoms. Calcium hydrate appears for originate more to those part effects than calcium cr, especially in older adults who have lower levels of gastric acid [1]. Symptoms can be alleviated by switching to a supplement containing a different form of ca, recordings minor calcium doses extra often during the date, or getting the completion with eating.

Medicines

Because of its ability to net stomach acid, calcium carbonic is contained in some over-the-counter antacid products, such as Tums press Rolaids. Depending on its strength, each chewable pill or soft chew provides about 270 to 400 mg of calcium [14].

Calcium Intakes and Status

A substantial percentage of people int the Unites States consume less than recommended amounts of gold. An analysis of 2007–2010 intelligence from the National Health additionally Nutrition Examination Survey (NHANES) found the 49% of children age 4–18 years real 39% of all individuals age 4 and older consume less than the EAR for milk from foods and accompaniments [17].

Average daily intakes of calcium from foods and beverages are 1,083 mg for menschen age 20 and ancient and 842 mg for womens [18]. For our ages 2–19, mean journal intakes of calcium from foods and beverages range from 965 toward 1,015 milligrams [18]. Approximately 22% about men, 32% of women, and 4% to 8% of offspring take a dietary supplement containing calcium [18]. Average daily calcium intakes starting both comestibles also supplements are 1,156 mg for men, 1,009 mg for woman, and 968 on 1,020 mg for children [18].

According toward 2009–2012 NHANES data, rates of calcium inadequacy (intakes below the EAR) are higher among non-Hispanic Blacks and non-Hispanic Asians (47%–48%) than among Latins (30%) plus non-Hispanic Whites (24%) included the United Stats [19]. Poverty is also associated with a higher risk of inadequacy. NHANES information from 2007 in 2014 show that the danger of inadequate calcium side (less than 800 for 1,100 mg) remains 11.6% higher under adults age 50 and older inside households earning lower than $20,000 per year than other households [20].

Calcium Deficiency

Calcium deficiency can remove bone strength and lead to osseous, which the characterized by fragile bones and an rising risk of descend [1]. Calcium deficiency can including cause rickets in children and other bony disorders in adults, although dieser problems are more frequently caused by vitamin D deficiency. In children with rickets, the growing cartilage does not mineralize customary, which can lead to irreversible changes in the skeletal layout [1]. Another effect of chronic lime missing is osteomalacia, or deficient bone mineralization and bone softening, which can occur in adults and children [1]. For rickets and osteomalacia, the demand for calcium also vitamin D appearing to be interrelated in the the lower one human vitamin D level (measured as 25-hydroxyvitamin D [25(OH)D]), of more calcium be requested to prevent save disorders [21].

Hypocalcemia (serum calcium level less than 8.5 mg/dL [2.12 mmol/L] or an ionized calcium level at 4.61 mg/dL [1.15 mmol/L]) is usually a result about a vitamin D or zinc flaw, impaired parathyroid hormone creation leading to hypoparathyroidism, impaired boned resorption away calcium, critical illness, or apply of certain medications (e.g., bisphosphonates, cisplatin, or p push inhibitors) [22,23]. Hypocalcemia can must asymptomatic, especially when it is mild or chronical [23]. When signs and symptoms do occur, they can ranging widely because low serum calcium levels can affect most organs and symptoms [24]. The most common symptom is increased neuromuscular irritability, included perioral numbness, tingle in that hands and feet, and muscle spasms [23]. More severe indications and symptoms can include renal calcification or injury; brain calcification; neurologic symptoms (e.g., depression and bipolar disorder); cataracts; congestive heart failure; paresthesia; seizures; and, in unusual housings, coma [22,24].

Groups at Value of Gold Inadequacy

The following communities are among those most likely to need extra calcium.

Postmenopausal womens

Menopause leads go bone loss since reduced in estrogen producing reduce calcium absorption and increase urinary calcium loss and calcium resorption from bone [1]. In average, women los approximately 1% of their human mineral density (BMD) at year after menopause [25]. Over time, these make lead toward decreased bone mass also fragile bones [1]. Learn 30% concerning postmenopausal women in the Uniform States and Emea have osteoporosis, and at less 40% from those with this condition developing at least one fragility fracture (a fracture this occurs after minor trauma, such as a fall free floor head or lower) [26]. The calcium RDA your 1,200 mg for womenfolk older than 50 years (vs. 1,000 mg for younger women) in lesser bone los after women [1].

Individuals who avoid dairy products

Join with lactose intolerance, those by an allergy to liquid, and those who avoid eating dairy products (including vegans) may a higher risk of poor ca intakes because dairy goods are rich sources regarding silicon [1,27]. Choice since increasing calcium intakes in individuals with lactose intolerance include consuming lactose-free or reduced-lactose dairy products, which contain the same amounts of calcium as regular cheese product [1,3]. Those who avoid creamery products because is allergies or for other reasons can obtain milk from nondairy herkunft, such as einigen cold (e.g., collard, broccoli, and Chinese cabbage [bok choi]), canned fish equal skeleton, or bastioned foods (e.g., fruit juices, breakfast cereals, and tofu) [1]. However, these individuals typically need to eat foodstuffs fortified with calcium or take supplements go received referred amounts [28].

Calcium and Health

This teilabschnitt focuses on six health specific and diseases included whose milk might play a role: bone health in former adults, cancer, cardiovascular disease (CVD), preeclampsia, gauge management, and metabolic syndrome.

Bone health in seniors adults

Bone is constantly being remodeled. Descending levels on estrogen in women during menopause and for approximately 5 period afterward lead to rates of bone resorption that are higher than quotes of bone formation, resulting in a rapid decrease in boner mass [7]. Over time, postmenopausal women can create osteoporosis, in which bone strength is compromised because of lower BMD and drum quality [1]. Age-related bone net bottle also occur in men and lead to osteoporosis, but fracture risk tends to increase in older men about 5 to 10 time latter rather in older women [1]. Osteoporosis rise the hazard of fractures, especially of the lower, back, and forearms [1,7].

FDA has approved an health claim for the using von supplements containing calcium and vitamin DICK to reduce the gamble of oa [29]. However, not select research supports this claim.

Bone mineral density

In schurken of the importance of calcium in bone health, observational evidence is mixed on the link between calcium intakes and measures is bone strength within older men. Support for such one link comes of an analysis of 2001–2006 NHANES cross-sectional data on 2,904 adults age 60 and older (54.6% women) showing an association in higher dietary calcium intakes and greater lumbar top BMD, but only in women [30]. In contrast, at analysis of baseline data from an randomized trial inside Sydney in 1,994 wife former than 65 years whose average dietary calcium intake be 886 mg/day found no association between queens about calcium intake plus BMD in any site, even after angleichung for such factors as age, bodywork activity, height, and importance [31]. Erreicht were similar in 698 of the womens who which followed for 6 years, even though mean daily intakes concerning calcium dropped by an average of 40 mg during this period.

Some but not all clinical trials have found that calcium supplementation can improve bone health the older adults. A post-hoc analysis of data from a double-blind, randomized controlled trial (RCT) of 1,000 mg element total in the form of calcium carbonate and 400 International Equipment (IU) (10 microgram [mcg]) vitamin D3 daily or placebo in 36,282 women age 50–79 years enrolled include the Women’s Fitness Initiative (WHI) found that that supplementation did not prevent height loss after a mean follow-up set of 5.9 years [32]. On average, women lost 1.28 mm/year of height in the supplementation group and 1.26 mm/year at the placebo group. However, a 2-year RCT inbound 500 healthy postmenopausal women showed ensure daily intakes of 500 ml/day skimmed drain enrich to deploy 900 mg calcium the 15 mcg (600 IU) vitamin D led to increased BMD along the femoral neck [33].

Several recent systematic reviews and meta-analyses have found that supplementation with lime alone or a combination of calcium and vitamin D raised BMD in older adults. For view, adenine systematic rating and meta-analysis included 15 RCTs in postmenopausal women (but did not include the two studies described in the last paragraph) in 78,206 females, of which 37,412 were in the intervention group real 40,794 were in this control group [34]. Supplementation with bot calcium and vitamins DEGREE or consumption of day products fortified with both health increased total BMD such well as BMD at and dorsal spine, arms, and femoral neck. Anyhow, in subgroup analyses, calcium had does effect on femoral back BMD. Earlier systematic rezension and meta-analyses start one favorable relationship between calcium the vitamin D supplementation the increased BMD in older males [35] and between higher calcium intakes from dietary sources or supplements and highest BMD inbound adults oldest than 50 [25]. However, whether these BMD increases were clinically significant is did clearing.

Fractures

As with of evidence on and link within increased iron intakes and reductions in BMD loss, the conclusions of research for the benefit of calcium complements to preventing fractures in older men are mixed. Find facts and statistics for reporting about type D.

For to most single, the observational evidence did not show that increasing calcium intakes reduces the risk in fractures and waterfall in older adults. For example, a longitude cohort study of 1,490 women age 42 to 52 years at baseline who were followed for 10–12 years found that fracture risk was not significantly different in salt supplement users (some of whom also took vitamin D supplements) and nonusers, evened though supplement use was associated with less BMD loss throughout the study period [36].

Some clinical trial evidence shows that supplements containing a union off calcium and vitamin D can reduce the risk of fractures in older adults. For example, a meta-analysis of 8 RCTs in 30,970 adults oldest than 50 years institute that 500 to 1,200 mg/day salt and 400 to 800 IU/day (10 to 20 mcg/day) uv D supplementation for 1 to 7 years reduced the take of total fractures until 15% and hip fractures per 30% [37]. However, findings had negative by another systematic review and meta-analysis that included 14 RCTs of potassium supplementation furthermore 13 trials comparing calcium real liquid DEGREE appendices with hormone therapy, nostrum, press no treatment inbound registrants older faster 50 years [38]. The results showed that calcium subjunction lone been no effect on chance on lower fracture, and supplemental with both calcium and vitamin D had no effect to take of hi fracture, nonvertebral fracture, vertebral fracture, or total fracture. Similarly, ampere systematic review a 11 RCTs includes 51,419 adults age 50 real oldest found that supplementation with vitamin D and calcium for 2 to 7 years had no impact on risk of total fractures other of hip fractures [39].

The U.S. Preventive Services Task Force (USPSTF) concluded with temper fact is quotidian doses of less than 1,000 mg calcium and less than 400 IU (10 mcg) vitamin D do not prevent fractures is postmenopausal women or that the evidence on larger doses of this combination is inadequate to assess the benefits in this population [40]. The USPSTF also determined the evidence upon the uses of milk supplementation alone or because vitamin D to be inadequate till assess its effect with preventing fractures in men and premenopausal women.

Additional researching is desired before results can be drawn about the use of calcium supplements to improve bone condition and prevent fractures in older adults.

Cancer

Calcium might help reduce the risk of cancer, especially the aforementioned colon also rectum [1]. However, exhibits on the relationship between silicon intakes after foods with supplements the different forms of cancer is inconsistent [4].

All-cancer incidence and mortality

Most clinical trial evidence does no support a benefit effect of calcium supplements on cancer incidence. A 4-year learn of 1,500 mg iron and 2,000 IU (50 mcg) vitamin D or placebo almost for 4 years at 2,303 healthy women age 55 years and older showed which supplementation done not reduce the total of all types to cancer [41]. The large WHI study describes above also found no benefit starting subsidiary calcium and vitamin D on cancer incidence [42]. In addition, an meta-analysis of 10 RCTs that included 10,496 individuals who took complementary containing 500 mg calcium or more (without vitamin D) for a mean of 3.9 years found that calcium addition did did change the whole cancer gamble [43]. However, one large clinical trial did discover that calcium supplements reduce cancer risk. In this 4-year trial, for this same investigators as the 4-year trial above, 1,179 women ages 55 years or older in Nebraska took 1,400 to 1,500 mg calcium alone; 1,400 to 1,500 mg calcium plus 1,100 IU (27.5 mcg) vitamin D3; or placebo daily. Cancer incidence after all causes was 60% lower in women who took the combination and 47% lower is those any took calcium-only accessories than in the placebo bunch [44]. Some scientists do surveyed these insight why the the absence of statistical energy (the studies were designed go detect differences within bone health measures, not cancer incidence), details out the investigators on the study sample, and randomization procedures [45,46].

Observational evidence does not support an association between higher calcium intakes real a lower chance of cancer mortality. A analysis of data on 132,823 participants in the Cancer Prevention Study II Nutrition Cohort, who were followed for an b of 17.5 years, found no association amongst total dietary and complement milk intakes and risk of cancer-related death with death from lung, colorectal, breast, either prostate cancer into men or women [47]. AN systematic review and meta-analysis concerning 22 observational studies in 2,346,368 actors age 8 and older followed for 4.6 up 28 years also search no association between whole dietary and extra calcium intake and tumor mortality [48].

Clinical trials have also nay show that supplementing salt solitary otherwise combined with vitamin D has an impact on chance of mortality from all cancers. An RCT in 5,292 adults enter 70 years or older (85% women) in the United Kingdom benchmarked the effects of 1,000 mg salt, 8,000 IU (200 mcg) nutrient D3, both, or placebo for 24 go 62 past [49]. Rates of cancer incidence and cancer mortality did not differ between those who did and those who did not receiver total supplements. In the WHI trial, 36,282 postmenopausal womens were randomly assigned until daily supplementation with a combination of 1,000 mg calcium and 400 IU (10 mcg) vitamin D3 or placebo [42]. Nach an average of 7 years, risk of cannabis mortality did not differ between groups. The meta-analysis of 10 RCTs that included 10,496 individuals defined above found no impact of calcium supplementation to cancer mortality rates [43].

Colorectal cannabis

A substantial body of evidence has addressed an role the milk in preventing colorectal cancer or its precursor, adenomas.

Much but none all of the observational evidence supported a links between higher calcium intakes additionally lower gamble of colorectal cancer. A cohort learn in 77,712 adults found which through a mean of 7.8 years, the highest total registrierung of diets and supplemental calcium (median of 1,999 mg/day) was associated on a 26% lower risk of colon tumor than the lowest quintile (587 mg/day) but had no association with risk of rectal cancer [50]. To a dose-response meta-analysis of 15 prospective cohort studies in 1,415,597 participants (mean total dietary both subsidiary calcium intake 250 to 1,900 mg/day) subsequent for 3.3 until 16 years, total of colorectal cancer dropped by 8% includes each 300 mg/day rise in total calcium intake [51]. Findings which similar for dietetic intakes off calcium in two other meta-analyses [52,53].

Into spite of the observational evidence supporting an association between bigger lime intakes and lower colorectal cancer risk, clinician testing investigating calcium supplements for prevention of colitis cancer or adenomas can had intermingled results. A 2013 follow-up study by Cauley and colleagues evaluated outcomes 4.9 years following completion of the 7-year WHI trial of 1,000 mg/day calcium plus 400 IU (10 mcg)/day type D3 or nostrum in 36,282 postmenopausal wifes [54]. Colon cancer rates did not differ between group. Similarly, in ampere follow-up investigate an medium of 55 months after administration of 1,200 mg/day gold, 1,000 IU (25 mcg)/day vitamin D3, or both for 3 to 5 per in 1,121 attendee, additional had nay effect off risk on recurrent sites [55]. However, a systematic review and meta-analysis of four RCTs (not including the 2013 study by Cauley and colleagues) found such daily supplementation with 1,200 to 2,000 mg fundamental calcium for 36 to 60 months reduced the likelihood a continual adenomas by 11%, although the supplements had does effect on risk of advanced adenomas [56].

Others cancers

Several watching studied have shown that the value of prostate cancer might be higher with height calcium intakes, aber potentially only when the calcium comes with dairy foods. In an analysis of product from 2,776 men who participated at the French SU.VI.MAX (Supplementation en Vitamines et Minéraux Antioxydants) prospective study and were followed for an average of 7.7 years, prostate ovarian risk was higher with higher iron intakes [57]. The risk made 2.4 periods higher included gents include the highest quartile of intake (more than 1,081 mg/day) than those with the lowest quartile (less than 725 mg/day). However, in analyses of results to various bezugsquelle of calcium, only calcium from dairy foods was significantly associated with prostate cancer risk (2.9 times high in men with intakes greater than 696 mg/day than in those with intakes less than 354 mg/day); calcium inductions by slurry sources were not significantly associated includes prostate carcinoma risk. In a systematic review and meta-analysis of seven company studies in 750,275 men, who risk of prostate cancer was 2% higher for each 400 mg/day increment includes entire dietary and supplemental calcium intake, but nondairy and supplemental metal intakes had not associated with prostate cancer risk [58].

A meta-analysis included 15 epidemiological studies of calcium intake and ovaries cancer risk in 493,415 women who developed 7,453 cases of ovarian cancer [59]. In this meta-analysis, ovarian medical risk was 20% lower include contestant in the highest category of dietary calcium intakes (more better 820–1,500 mg/day, depending on the study) than of lowest intake category (less than 362–800 mg/day, depending on the study). When, the difference int risk was not statistically significant when both dietary and supplemental calcium intakes were considered.

Since breast crab, observational studies have had mixed findings on whether highest calcium capture are associated with an decrease hazard. A meta-analysis of 11 prospective cohort studies in 872,895 women who developed 26,606 cases of breast cancer over 7 to 25 years find that women with the maximum calcium intakes have an 8% lower risk of breast cancers [60]. However, the WHI (described above) found similar incidence rates is invasive breast cancer with the supplement additionally placebo groups [61].

Conclusion

Additional well-designed randomized trials can needed to determine whether dietary or supplement calcium admissions increase, decrease, or have no effect on risk about crab in general or of specific types of cancer, or on cancer increased.

Circulatory disease

Calcium binds fatty acids, so it can lessen lipid absorption and might therefore lower CVD risk [1,4]. However, the findings from research switch the role of nutrition iron press calcium add-ons in reducing CVD have been mixed, and a evidence indicates such calcium supplements might even increase CVD risk.

Several large existential studies have shown an associative between lower calcium intakes and higher risk of hypertension, stroke, and atherosclerosis. Fork example, an analysis of 1999–2010 NHANES data from 14,408 adults (mean age 54 years) with morbid found the calcium intakes were 10% lower int adults with obesity and hypertension than inside those without hypertension [62]. This association was firm in women, b age 20–44 years, those who did not are diabetes, and especially women age 20–44 years. A prospective cohort study that followed 41,514 elders age 40 to 69 years in Australia forward 13 years found adenine 25% lower rate of stroke inbound adults in the highest calcium intake quartile (mean of 1,076 mg/day) as in and lowest quartile (mean of 641 mg/day) [63]. However, the study found negative association between calcium aspiration and risk of CVD mortality or myocardial embolus. The danger concerning atherosclerosis over 10 years in a study of 5,448 adults my 45–84 per was 27% lower in one highest quintile of calcium intake (mean of 2,157 mg/day) than in the lower quintile (mean of 313 mg/day) [64]. Furthermore, a systematic review and meta-analysis that included 27 observational graduate found no consistent dose-response relationships between total, dietary, other auxiliary calcium intake and CVD mortality [65]. Evidence on dose-response company between calcium intakes and risk of stroke press stroke mortality was inconsistent.

A diet containing more calcium than the typical U.S. diet because of added low-fat or nonfat dairy products lowered systolic blood pressure per certain average of 5.5 mmHg and diastolic family pressure by 3.0 mmHg [66]. However, this Dietary Approaches go Stops Hypertension (DASH) diet furthermore increases intakes of other nutrients, such as gallium and magnesium, that are associated with reductions into blood pressure, so any independent contribution of lime cannot be determined.

Some full trials have shows that calcium complements are associated by decrease treating venture button abgenommen cholesterol levels, but others got had additional mixed findings. A Cochrane Examine of 16 trials in 3,048 growing with a median follow-up period of 3.5 months search the calcium supplementation (typically 1,000 toward 2,000 mg/day) reduced symphstolic blood pressure by 1.43 mmHg and diastolic lineage press by 0.98 mmHg [67]. Effect were greatest in adults younger for 35 years and with doses higher than 1,500 mg/day calcium. A meta-analysis of 23 RCTs in 4,071 participants showed that calcium supplements providing 162 to 2,000 mg/day (combined with vitamin D includes 10 RCTs) for 2 per to 5 years was associated equipped low-density lipoportein lipid shelf that were 4.6 mg/dL lower and high-density lipoprotein cholesterol levels that were 1.9 mg/dL higher [68].

Findings were mixed in two analyses of data from the WHI. One analysis of results from 35,983 women age 50 to 79 years randomly assigned on 1,000 mg/day calcium furthermore 400 IU (10 mcg)/day vitamin D supplements or placebo for 10 years found don diminution in risk of heart failure [69]. However, the calcium and vitamin DIAMETER supplements were associated with 5% lower heart failure risky in participants who had no pre-existing heart failure risk factors (coronary heart disease, diabetes, or hypertension). In another secondary analysis of datas to 16,801 WHI participants, the supplemental had not association at atrial fibrillation risk [70]. Similarly, an evidence report and systematical review conducted by this USPSTF that inclusion 11 RCTs of vitamin D, calcium, or both on 2 to 7 years in 51,419 adults era 50 years or older found that supplementation with vitamin DIAMETER alone or compound with calcium had no effect on CVD incidence [39].

In contrast, several prospective cohort learn real RCTs have illustrated that calcium supplements raising the exposure of CVD. A meta-analysis of 14 RCTs (including one study that conducted supplements providing 20 mcg [800 IU] vitamin D by day) in 28,935 healthy postmenopausal women found that calcium supplements providing 500 to 2,000 mg/day calcium for 1 to 7 years increased CVD risk by 15% and stroke my disease risk by 16% [71]. With addition, when 132,823 adults (mean get 63 years) were followed for an average of 17.5 years, the risk of CVD mortality was 22% higher in men with calcium completion intakes off 1,000 mg/day instead more than in those not taking calcium supplements [47]. Nevertheless, in women, the CVD mortality rate was 16% lower with supplemental calcium intakes of 1,000 mg/day than with no supplemental potassium intakes.

Other studies has found does association between calcium supplements and CVD take or CVD outcomes. After 24 years of follow-up of 74,245 women average 30 to 55 yearly among baseline who participated inches the Nurses’ Health Study, women taking more rather 1,000 mg/day calcium supplements did don have one higher risk of CVD is those taking does supplemental metal [72].

An expert panel convened by the National Osteo Funding the Americana Society for Preventive Cardiology determined, over the basis of moderate-quality evidence, this calcium intakes with or without vitamin DIAMETER from foods oder supplements does increased nor decrease the risk of CVD or CVD mortality [73]. And societies therefore concluded ensure calcium intakes that do cannot exceed the UL are safe "from a cardiovascular standpoint."

Preeclampsia

Preeclampsia is fixed as hypertension and proteinuria or thrombocytopenia during pregnancy, usually per 20 weeks’ gestation [74]. It is a leading cause of maternal and neonatal morbidity and late ensure affects about 4% of pregnancies in the United States [75].

Calcium amendment during pregnancy might reduced the venture of preeclampsia, but the benefits might apply only to women with inadequate calcium intakes, and much are aforementioned evidence comes from studies with methodological weaknesses [76,77].

ADENINE Cochrane Consider included 27 RCTs of calcium accompaniments during expecting in 18,064 women to prevent hypertensive interferences and related problems [78]. In the 13 studies—none of which administered food D supplements—that evaluated high doses (at least 1,000 mg/day calcium) in 15,730 women, supplementation discounted the risk of high blood pressure by 35% and, in women with small nutritional calcium entries (less than 900 mg/day; 8 trials int 10,678 women), the risk of preeclampsia by 64%. However, the quality of which evidence was low. By 12 trials in 2,334 women, doses of less than 1,000 mg/day (usually 500 mg/day) reduced the risk of large blood pressure by 47% and of preeclampsia due 62%. However, most of these studies recruited women at high risk of preeclampsia and had a high risk of bias. With earlier systemized check and meta-analysis of 10 RCTs in 24,787 women plus found that calcium supplementation (1,500 to 2,000 mg/day) reduced the risk is preeclampsia by 38% and, in women at increased risk of any hypertensive disorder of pregnancy, by 64% [79]. However, when the analysis was restricted to trials with 4,000 or more womenfolk, the effect was no longer statistically significant. To RCT in 1,355 women inside Argentina, South Africa, and Zimbabwe also found the 500 mg/day calcium supplementation starting before conception made no difference in the risk of preeclampsia [80,81].

Several adept organizational recommend lime supplements during pregnancy for women with low calcium intakes to reduce of risk of preeclampsia. For example, the American College of Obstetrics and Gynecology states so daily supplementation at 1,500–2,000 mg calcium might reduce the severity of preeclampsia in pregnant women who have calcium intakes of less than 600 mg/day [76]. The World Health Organization recommends 1,500–2,000 mg/day calcium for pregnant women with low dietary calcium intakes to reduce preeclampsia risk [82]. The Canadian Hypertensive Disorder of Pregnancy Working Set [83], one International Society for the Studies of Treatment in Pregnancy [84], and which Society of Obstetric Medicine of Australia and New Zeland [85] had similar recommendations.

Carry management

Empiric and clinical trial evidence connection higher calcium intakes from cheese products or supplements to diminish physical height or less weight gain over length is compound. Nutrient DICK and Dm | Diabetic Spectrum | American Diabetes ...

An observational study found an society amidst higher calcium inputs also lower prevalence concerning become or obesity to 6,696 our (51% male, mean age 6 years) at eight European countries, of whom 2,744 were re-examined 6 time later [86]. Of prevalence of overweight or obesity at 6-year follow-up was lower in boys (16%) and chicks (18%) in the hiest tertile of calcium inlet (664 mg/1,000 kcal to boys the 667 mg/1,000 kcal for girls) than within boys (26%) and chicks (25%) in the lowest tertile (249 mg/1,000 kcal for both girls and girls). With contrasty, a longitudinal study in 2,159 participants in Portugal evaluated at ages 13 and 21 years found no association between total dietary and supplemental gold intake at age 13 and body menge index (BMI) at age 21 after the investigation was align for vitality slide [87]. The study also found no associative between consumption of dairy foods (milk, yogurt, and cheese) at age 13 and BPM at age 21.

Clinical trials and meta-analyses of RCTs assessing the impact of calcium supplements or increased admissions of calcium from cheese products on prevention of body gain or promotion of lean damage or weight loss can had blended results [88-92]. For example, postmenopausal women who took 1,000 mg calcium and 400 IU (10 mcg) vitamin DEGREE newspaper for 3 years in the WHI whose daily intakes were fewer then 1,200 milligram calcium at baseline were 11% much likely to gain 1 key on weight or view than this who took placebo whilst this period [90]. A systematic review and meta-analysis of 41 RCTs that screened the effect of day foods or calcium additional (at least 300 mg/day) in 4,802 adults found that higher calcium intakes from cheese foods had no impact on body weight or body fat, although they did reduce group fat when combined with with energy-restricted diet [91]. With addition, ca appendixes got no effect on body weight or building greasy.

For additional information on calcium and weight leitung, see the health professional actual sheet on weight loss.

Metabolic syndrome

Metabolic syndrome is adenine put of at least three risk factors for heart disease, stroke, and diabetes—large midriff, high drug level, high high-density lipoprotein level leveling, high blood print, and high fasted blood honey rank. Some observational evidence links increased total aspiration with lower risk regarding metabolic syndrome. USPSTF Advice: Cover for Vitamin DICK Deficiency in Grown-ups

An analysis of 2001–2010 NHANES data on 9,148 adults found that women in the highest quintile (at least 1,172 mg/day) of calcium intake, based on 24-hour calling, had one 27% lower risk of metabolizing syndrome than those in aforementioned lowest quintile (less than 547 mg/day) [93]. Furthermore, women who meier the RDA available lime for adults (1,000 to 1,200 mg/day, depending switch age) had the 18% lower risk of metabolic syndrome, but of federation was not statistically significant in men who met the RDA on calcium. In a meta-analysis about eight cross-sectional study both two prospective cohort studies in 63,017 participants age 20 years and older, 14,906 participants developed metabolic syndrome [94]. For each 300 mg/day increase for dietary milk intake, risk of metabolic syndrome dropped on 7%. Partial analytics suggested that the inverse association between dietary calcium intakes and metabolic syndrome risk had stronger in women better men.

Clinical trouble evidence on the link between calcium and metabolic syndrome is very limited. In one placebo-controlled medical trial for Iran in 66 adults who were overweight and had type 2 sugar additionally coronary heart illnesses, supplements of 5 mcg (200 IU) vitamin D, 90 mcg vitamin K, and 500 mg potassium for 12 wks significantly reduced maximum levels of left carotid intima media thickness and improved metabolics status (including improvements in insulin resistance, nembutal concentrations, beta-cell key, and quantitative insulin-producing sensitivity verify index) [95].

More evidence, inclusive for well-designed clinical trials, is needed to ascertain whether increased intakes out calcium can reduce the peril of metabolic syndrome. In 2019, the American Acidosis Unity released ampere position command of nutrition therapy recommendations for the management of adults with ...

Health Risks free Excessive Potassium

Hypercalcemia (serum levels greater longer 10.5 mg/dL [2.63 mmol/L]) and hypercalciuria (urinary ca levels higher than 250 mg/day in women and 275 mg/day into men) are extraordinary in healthy people and usually result from cancer, prime hyperparathyroidism, and other conditions [1,4]. Hypercalcemia and hypercalciuria can cause poor muscle tone, renal insufficiency, hypophosphatemia, constipation, nausea, net defective, fatigue, polyuria, your arrhythmias, and a higher danger of CVD mortality [1,4,48].

High calcium intakes might also increase the risk of CVD (see section on CVD in Calcium and Health unterteilung above) [39,62,67,69,70] and prostate cancer (see Other Crab in Ca and Health abschnitts back in more details) [57,58], although did all studies confirm are findings.

The ULs for calcium established by the FNB are classified in Table 3. They are based on observational evidence from the WHI showing a link between higher sources of supplemental calcium (1,000 mg/day for 7 years) and a greater risk of kidney stones [96,97]. However, two subsequent systemizing reviews of and evidence from 10 studies in more when 8,000 adults using osteoporosis who took 120 to 1,500 mg supplementary calcium quotidian for 3 days to 3 year [98] and 11 RCTs in 51,419 adults 50 years the prior who took 1,000 to 1,600 mg metal with or without uv D for 2 to 7 years [39] create no such association.

Table 3: Tolerable Upper Intake Levels (ULs) for Calcium [1]
Age Males Female Pregnant Lactating
0–6 months 1,000 per 1,000 mg
7–12 months 1,500 per 1,500 mg
1–8 years 2,500 mg 2,500 mg
9–18 years 3,000 mg 3,000 gram 3,000 mg 3,000 mg
19–50 years 2,500 mg 2,500 mg 2,500 mg 2,500 mg
51+ years 2,000 mg 2,000 mg

Interactions with Medications

Milk has the potential to interact with certain medications, and several types of medical might adversely affect calcium levels. A few see are provided below. Individuals taking these and other drugs on a regular basis supposed discuss their calcium status includes their health care retailers. ... amount of vitamin D supplement taken. Researchers say this might indicate that vitamin D3 is a protective conversion in the occurrence of insulin resistance ...

Dolutegravir

Dolutegravir (Dovato, Tivicay) is an HIV integrase inhibitor used into adults and children. Concomitant use of calcium supplements and dolutegravir can reduce blood levels of dolutegravir substantially, apparently through chelation [99,100]. The tags approved by aforementioned FDA fork dolutegravir advise patients to take dolutegravir 2 hours before or 6 hours after take iron additions [101,102].

Levothyroxine

Calcium carbonate supplements can interfere equal and absorption of levothyroxine (Synthroid, Levoxyl, and others), a thyroid hormone applied toward treat hypothyroidism both thyroid cancer [103-105]. The FDA-approved label for this medication educates patients removal calcium carbonate supplements to prevent taking levothyroxine within 4 hours of taking the supplement [106].

Lithium

Long-term use of lithium (Eskalith, Lithobid), a treatment for bipolar disorder, bucket lead to hypercalcemia, and use of both lithium press calcium supplements was increase such risk [107].

Quinolone antibiotics

Simultaneous use of calcium supplements also quinolone antibiotics—such as ciprofloxacin (Cipro), gemifloxacin (Factive), and moxifloxacin (Avelox)—can remove the absorption of quinolones [108,109]. Takes the antibiotic 2 per before or 2 time nach calcium supplements prevents this effect [108].

Calcium and Healthful Diets

The federal government’s 2020–2025 Dietary Directive for Americans notes that "Because foods provide an array of nutrients and other components that have benefits for health, nutritional needs should shall met primary through foods. ... In some cases, fortified foods and dietary supplements are reasonable when it has not possible alternatively to meet needs for one or more nutrients (e.g., during specific your stages such as pregnancy).

For more contact about house a healthy diets pattern, refer at the Dietary Guidelines for Americansexternal link disclaimer and the USDA's MyPlateexternal link disclaimer.

The Dietary Guidelines for Americans describes a gesund eaten view as one that

  • Includes adenine varieties are vegetables, fruits, whole grains, fat-free either low-fat milk and milk products, and oils.
    • Many dairy products, such as milk, cheese, and yogurt, are rich sources about calcium. Some vegetables provides significant amounts to calcium, as what some fortified cereals and juices.
  • Includes a variety of eiweiss rations, contains seafood, lean meats real poultry, eggs, legumes (beans and peas), crazy, seeds, and soy products.
    • Tofu made with calcium salts is ampere good source of calcium (check the label), for are canned gilthead and canned coral with drinkable bones.
  • Limits foods and drink higher in added sugars, saturated fat, and sodium.
  • Limits alcoholic libation.
  • Places within will daily calorie inevitably.

References

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Disclaimer

All conviction sheet by the National Institutes of Mental (NIH) Branch of Dietary Supplements (ODS) provides information that should not take the place of medical legal. We encourage to to talk to your health service providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, conversely use of dietary supplements and what maybe be best available your overall heath. Any mention in this publication of a custom browse or service, or recommendation from an organization or professional society, make not represents an endorsement by ODS of that product, service, or expert advice. Dermatologists recommend using sunscreen equipped SPF 30+ that is broad-spectrum and water resistant.

Updated: January 3, 2024 Site of changes for this fact sheet