Calcium status assessment at the population level: Candidate approaches and challenges

Abstract

Inadequate dietary calcium intake is a global public health problem that disproportionately affects low-and middle-income countries. However, the calcium status of a population is challenging to measure, and there are no standard methods to identify high-risk communities even in settings with an elevated prevalence of a disease caused or exacerbated by low calcium intake (e.g., rickets). The calcium status of a population depends on numerous factors, including intake of calcium-rich foods; the bioavailability of the types of calcium consumed in foods and supplements; and population characteristics, including age, sex, vitamin D status, and genetic attributes that influence calcium retention and absorption. The aim of this narrative review was to assess candidate indicators of population-level calcium status based on a range of biomarkers and measurement methods, including dietary assessment, calcium balance studies, hormonal factors related to calcium, and health outcomes associated with low calcium status. Several promising approaches were identified, but there was insufficient evidence of the suitability of any single indicator to assess population calcium status. Further research is required to develop and validate specific indicators of calcium status that could be derived from the analysis of data or samples that are feasibly collected in population-based surveys.

Could local foods achieve recommended calcium intakes for nutritionally vulnerable populations in Uganda, Guatemala, and Bangladesh?

“…In settings where women have low dietary calcium intakes, high‐dose calcium supplementation during pregnancy can reduce preeclampsia risk by half 7,8 . Further positive effects of maternal calcium supplementation during pregnancy may extend to children beyond the postnatal period; 9 however, the impact of calcium supplementation on bone health for both mothers and their children is unknown 10,11 . Regardless, calcium supplementation is unlikely to be a feasible or effective method of addressing insufficient calcium intakes for the broader population, due to high costs and requirements for large doses and burdensome dosing schedules 7 .…”

“…7,8 Further positive effects of maternal calcium supplementation during pregnancy may extend to children beyond the postnatal period; 9 however, the impact of calcium supplementation on bone health for both mothers and their children is unknown. 10,11 Regardless, calcium supplementation is unlikely to be a feasible or effective method of addressing insufficient calcium intakes for the broader population, due to high costs and requirements for large doses and burdensome dosing schedules. 7 Therefore, for the broader population, in areas where calcium intakes are low, other strategies, such as food-based approaches, are necessary and may prove effective.…”