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Meta-Analysis
. 2014 Sep 25:12:158.
doi: 10.1186/s12916-014-0158-6.

Dietary calcium intake and mortality risk from cardiovascular disease and all causes: a meta-analysis of prospective cohort studies

Xia Wang, Hongxia Chen, Yingying Ouyang, Jun Liu, Gang Zhao, Wei Bao  1 , Maosheng Yan
Affiliations
Meta-Analysis

Dietary calcium intake and mortality risk from cardiovascular disease and all causes: a meta-analysis of prospective cohort studies

Xia Wang et al. BMC Med. .

Abstract

Background: Considerable controversy exists regarding the association between dietary calcium intake and risk of mortality from cardiovascular disease and all causes. Therefore, we performed a meta-analysis of prospective cohort studies to examine the controversy.

Methods: We identified relevant studies by searching MEDLINE, Embase, and the Cochrane Library databases between 1 September 2013 and 30 December 2013. Reference lists of relevant articles were also reviewed. Observational prospective studies that reported relative risks and 95% confidence intervals for the association of calcium intake with cardiovascular and all-cause mortality were eligible. Study-specific relative risks were pooled using a random-effects model.

Results: In this meta-analysis, 11 prospective studies with 12 independent cohorts, involving 757,304 participants, were eligible. There was evidence of a non-linear association between dietary calcium intake and risk of mortality from cardiovascular disease (P for non-linearity <0.01) and all causes (P for non-linearity <0.01). A dose-response analysis showed a U-shaped relationship between dietary calcium intake and cardiovascular mortality. Intakes that were lower and higher than around 800 mg/day were gradually associated with a higher risk of cardiovascular mortality. For all-cause mortality, we also observed a threshold effect at intakes around 900 mg/day. The risk of all-cause mortality did not decrease further at intakes above 900 mg/day.

Conclusions: This meta-analysis of prospective cohort studies suggests that dietary calcium intake is associated with cardiovascular mortality in a U-shaped manner and that high dietary calcium intake (>900 mg/day) is not associated with a decreased risk of all-cause mortality.

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Figures

Figure 1
Figure 1
Flow chart of study selection. Shows literature search for prospective cohort studies of calcium intake in relation to cardiovascular and all-cause mortality.
Figure 2
Figure 2
Dietary calcium intake and risk of cardiovascular mortality. Forest plot presents association between dietary calcium intake and risk of cardiovascular mortality when comparing the highest to the lowest level of dietary calcium intake. CI, confidence interval; RR, relative risk.
Figure 3
Figure 3
Dose-response analyses relating dietary calcium intake to cardiovascular mortality. Relative risks of cardiovascular mortality associated with total dietary calcium intake. Calcium intake was modeled with restricted cubic splines by a random-effects dose-response model. A calcium intake of 800 mg/d was used as the reference to estimate all relative risks.
See this image and copyright information in PMC

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