JAMA report criticizing calcium supplementation in men raises eyebrows among supplement associations

CHICAGO — A JAMA report released Monday afternoon that suggested a high intake of supplemental calcium is associated with an increased risk of cardiovascular disease death in men was criticized by several dietary supplement agencies for being inconclusive. According to the Council for Responsible Nutrition's most recent survey of U.S. adults, 17% indicated they take a calcium supplement.

"This study has the same unfortunate design defects as previous studies yielding mixed results," stated Taylor Wallace, senior director, scientific and regulatory affairs, CRN. "The National Institutes of Health–AARP Diet & Health Study was originally designed by researchers at the National Cancer Institute to look specifically at epidemiologic investigations of diet and cancer, not to measure cardiovascular or cerebrovascular outcomes," he said. "The science behind the safety and benefit of calcium supplementation is well-established; and this study proves inconsistent with a recent wave of new research that concludes that calcium supplementation is beneficial to bone health, and also poses no risk to cardiovascular health."

"While this study includes a large population and a long follow-up time, it also has weaknesses in that it doesn’t capture all the pertinent information regarding duration of calcium supplementation or other nutrients," commented Cara Welch, SVP scientific and regulatory affairs Natural Products Association. "The Natural Products Association does not believe that this study should cause anyone to stop taking their calcium supplements. We have long recommended that you should discuss your calcium intake with your healthcare professional.”

Taylor noted that dietary supplement usage has increased dramatically over the course of time encompassed by the study and subsequent follow-up. "This includes calcium supplement usage which has increased among men in the past two decades as dairy consumption has decreased and the incidence of osteoporosis among this population has become increasingly evident," he said. "The results of this study are most likely confounded by the lack of data collected during the 11-year follow up because the number of baseline nonusers who became users of calcium supplements was likely to have increased substantially."

The study consisted of more than 388,000 participants from the National Institutes of Health–AARP Diet & Health Study between the ages of 50 and 71 years, according to a report published online first by JAMA Internal Medicine, a JAMA Network publication. During an average 12 years of follow-up, researchers noted that 7,904 cardiovascular disease deaths in men and 3,874 cardiovascular disease deaths in women were identified and supplements containing calcium were used by 51% of men and 70% of women, respectively. “In this large, prospective study we found that supplemental but not dietary calcium intake was associated with an increased CVD mortality in men but not in women,” the authors concluded. For women, supplemental calcium intake was not associated with CVD death, heart disease death or cerebrovascular disease death. Dietary calcium intake also was not associated with CVD death in men or women.

“Whether there is a sex difference in the cardiovascular effect of calcium supplement warrants further investigation. Given the extensive use of calcium supplement in the population, it is of great importance to assess the effect of supplemental calcium use beyond bone health,” the authors concluded.

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