Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 14;19(4):2119.
doi: 10.3390/ijerph19042119.

Association of Dietary Calcium Intake with Dental, Skeletal and Non-Skeletal Fluorosis among Women in the Ethiopian Rift Valley

Demmelash Mulualem  1 , Dejene Hailu  2 , Masresha Tessema  3 , Susan Joyce Whiting  4
Affiliations

Association of Dietary Calcium Intake with Dental, Skeletal and Non-Skeletal Fluorosis among Women in the Ethiopian Rift Valley

Demmelash Mulualem et al. Int J Environ Res Public Health. .

Abstract

Fluorosis is a major public health problem in the Rift Valley of Ethiopia. Low calcium (Ca) intake may worsen fluorosis symptoms. We assessed the occurrence of fluorosis symptoms among women living in high-fluoride (F) communities in South Ethiopia and their associations with dietary Ca intake. Women (n = 270) from two villages provided clinical and questionnaire data. Dental fluorosis examination was done using Dean's Index, and skeletal and non-skeletal fluorosis assessment was carried out using physical tests and clinical symptoms. Daily Ca intake was estimated by a food frequency questionnaire. Food, drinking water and beverage samples were analyzed for F level. Many subjects (56.3%) exhibited dental fluorosis. One-third of the women were unable to perform the physical exercises indicative of skeletal fluorosis; about half had ≥2 symptoms of skeletal/non-skeletal fluorosis. The average F level in drinking water sources was ~5 mg/L. The F content in staple food samples varied from 0.8-13.6 mg/kg. Average Ca intake was 406 ± 97 mg/day. Women having ≤400 mg/day Ca intake had ~3 times greater odds of developing skeletal rigidity with joint pains [AOR = 2.8, 95%CI: 1.6, 5.0] and muscular weakness [AOR = 2.9, 95%CI: 1.3, 6.3] compared to those with higher intakes. No association of calcium intake was seen with dental fluorosis. As low dietary Ca intake was associated with symptoms related to skeletal and non-skeletal fluorosis, this warrants nutritional intervention on calcium intakes in this setting.

Keywords: Ethiopian Rift Valley; calcium intake; dental fluorosis; fluoride; non-skeletal fluorosis; skeletal fluorosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

References

    1. WHO . Guidelines for Drinking-Water Quality. 3rd ed. Volume 1 World Health Organization; Geneva, Switzerland: 2008.
    1. Kebede A., Retta N., Abuye C., Whiting S.J., Kassaw M., Zeru T., Tessema M., Kjellevold M. Dietary fluoride intake and associated skeletal and dental fluorosis in school age children in rural Ethiopian Rift Valley. Int. J. Environ. Res. Publ. Health. 2016;13:756. doi: 10.3390/ijerph13080756. - DOI - PMC - PubMed
    1. Assefa G., Shifera G., Melaku Z., Haimanot R.T. Clinical and radiological prevalence of skeletal fluorosis among retired employees of Wonji-Shoa sugar estate in Ethiopia. East Afr. Med. J. 2004;81:638–640. doi: 10.4314/eamj.v81i12.9250. - DOI - PubMed
    1. Kravchenko J., Rango T., Akushevich I., Atlaw B., McCornick P.G. The effect of non-fluoride factors on risk of dental fluorosis: Evidence from rural population of the Main Ethiopian Rift. Sci. Total Environ. 2014;488–489:595–606. doi: 10.1016/j.scitotenv.2013.12.087. - DOI - PubMed
    1. Melaku Z., Assefa G., Enqusilassie F., Bjorvatn K., Tekle-Haimanot R. Epidemiology of skeletal fluorosis in Wonji Shoa Sugar Estate, Wonji, Ethiopia: A community based survey. Ethiop. Med. J. 2012;50:307–313. - PubMed

Publication types