Table 1 Randomized controlled trials (RCTs) for weight loss investigating the effects of calcium with and without vitamin D on body fatness

From: Calcium and vitamin D for obesity: a review of randomized controlled trials

Authors Study location Study details Results Significance and direction of loss in measures of body fatness Comments
     BW WC or WHR FM or %FM FFM  
I Studies designed primarily for weight and body composition changes
Cummings (2006) Perth, Australia Study: single-blind crossover, comparing two energy-restricted dairy diets: (1) high in dairy Ca (HC—1200 mg/d) or low in Ca (LC—600 mg/d).
Subjects: 40 men and women, mean BMI 32.8 kg/m2, n=29 completers.
Duration: 12 weeks on each arm with 12 week washout.
Primary outcome: weight and fat loss, intention-to-treat analysis.
No treatment effect on weight and FM loss observed. Decrease in WC greater on HC (P=0.052). No Trend ↑ No No Yogurt given to both groups, experimental had additional calcium
Faghih et al. (2010) Iran Study: single-blind parallel, comparing four reduced calorie regimens (−500 kcal/day): (1) control diet (500–600 mg/day Ca), (2) Ca supplemented diet−control+800 mg/day Ca carbonate (3) milk diet (three serves of low-fat milk) and (4) soy milk diet (three serves of Ca-fortified soy milk).
Subjects: 100 pre-menopausal women, mean BMI 30.86 kg/m2.
Duration: 8 weeks.
Primary outcome: Weight and fat loss
Significant treatment effects for waist and WHR and trends for weight and BMI, favouring soy plus calcium and dairy over control diet. No significance for high calcium.
Weight reductions in high milk, soy milk, calcium supplement and control groups were 4.43±1.93 kg, 3.46±1.28 kg, 3.89±2.40 and 2.87±1.55 kg, respectively.
No No No No Baseline consumption of calcium=<600 mg/day
Gilbert et al. (2011) Canada Study: parallel energy-restricted program (−600 kcal/d) with either milk-based calcium supplement (1000 mg Ca/d) or isoenergetic placebo (rice based). Subjects: 41 women, low Ca consumers (800 mg Ca/d), mean BMI at baseline 33.05 kg/m2. 25 completers at 6 months (Placebo n=12 and Milk n=13).
Duration: 6 months.
Primary outcome: subjective hunger/satiety, food intake, weight and fat loss.
Milk group had a small increase in appetite sensations than placebo group.
Time × treatment interactions for: (1) desire to eat P=0.03, and (2) hunger P=0.047.
No treatment or treatment × time interaction observed for weight loss, FM and FFM. Percentage of FM lost was lower in milk group (P=0.06). No differences in glucose, insulin, leptin, ghrelin and cortisol.
No No No No Trend for lower fat intake on treatment arm (P=0.06)
Holecki et al. (2008) Poland Study: subjects divided in two groups based on age and BMI. Group 1 was given Ca Carbonate and 1-(OH)-vitD supplement; and group 2 was provided with only a diet.
Subject: 40 women, mean BMI 36.2 kg/m2.
Duration: 3-month weight reduction.
Primary outcome: evaluate influence of Ca and vitamin D supplementation on weight and fat loss.
No significant differences of body weight, fat content, serum parathormone,25-(OH)-D3 concentration plasma total Ca and P concentration were observed between groups. No No No   Ca with vitamin D supplementation showed no additional effect on weight loss
Kabrnová-Hlavatá et al. (2008) Czech Republic Study: three arm parallel RCT emphasizing 2.5 MJ/d energy deficit and daily Ca intake of 350 mg plus placebo, or Ca carbonate (500 mg/d) or dairy Ca (lactoval, 500 mg/d). One week run in for weight stability.
Subject: 37 women, BMI 32.2 kg/m2.
Duration: 3 weeks.
Primary outcome: weight maintenance.
No between-group difference in weight loss and body composition.
Addition of Ca resulted in lower hunger score and plasma resistin levels.
Ca lead to preservation of FFM compared with placebo.
No No Yes↓ Lactoval was prepared from milk and contained calcium as phosphate (70%), lactate (10%) and citrate (20%)
Major et al. (2009) Canada Study: double-blind, placebo-controlled weight reducing programme; 2900 kJ/d+Ca and VitD supplementation (1200 mg/d elemental Ca and 10 μg/d VitD).
Subject: sub analysis of very low consumers (<600 mg/d Ca), mean BMI 30.95 kg/m2, n=7 for Ca and Vit D and n=6 for placebo.
Duration: 15-week.
Primary outcome: Body fat and food intake
Group comparison showed no significant ↓ in food intake with supplementation.
Supplementation in very low-Ca consumers (600 mg/d) resulted in:
significant ↓ in body weight and fat mass (P=<0.01)
significant ↓ in spontaneous dietary lipid intake (P<0.05)
+ve correlation between fat mass and lipid intake
Yes↑ Yes↑ Yes↑ No Secondary analysis.
No significant fat loss in either group despite caloric restriction
Major et al. (2007) Canada Study: same as above.
Subject: 63 women, reported Ca intake<800 mg/day, mean BMI 32 kg/m2.
Duration: 15 weeks.
Primary outcome: Lipoprotein and plasma lipid during weight loss.
Supplementation induced no significant ↑ in fat-mass loss with whole-group comparison No No No  
Wagner et al. (2007) USA Study: 500-Kcal restriction diet containing 750 mg Ca/d with exercises three times/week+either (1) Ca lactate (800 mg Ca/d), (2) Ca phosphate (800 mg Ca/d), (3) low-fat milk (800 mg Ca/d), or (4) placebo capsules.
Subject: 58 subjects (Ca lactate, n=12; Ca phosphate, n=; milk, n=17 and placebo, n=13), mean BMI 33.2 kg/m2.
Duration: 12 weeks.
Primary outcome: body weight and composition and markers of bone turnover.
No treatment effect on body weight.
Body fat decreased in each group, with milk group showing the least change—but no between-group effects.
No No  
Zemel et al. (2005) USA Study: three arm parallel study of 500 kcal/d deficit diets—
1 standard diet (400–500 mg Ca/d+placebo)
2 high-Ca diet (Standard diet+800 mg elemental Ca/d=1200–1300 mg Ca/d)
3 high-dairy diet (1200–1300 mg Ca/d+placebo).
Subject: 32 obese subjects, mean BMI 34.9 kg/m2.
Duration: 24 weeks.
Primary outcome: body weight and fat loss.
Greater weight loss, fat loss and trunk-fat loss in rank order,
high dairy>high calcium>low calcium.
Circulating leptin followed a similar pattern to body fat (P<0.01)
Yes↑ Yes↑ Yes↑  
Zemel et al. (2009) USA Study: four-site, three-arm parallel study of 500 kcal/d deficit diets—
1 standard diet (500 mg Ca/d+placebo)
2 high-Ca diet (standard diet+900 mg elemental Ca/d=1400 mg Ca/d)
3 high three serves of dairy diet (1400 mg Ca/d ).
Subject: 106 overweight/obese subjects, only 68 adherent to protocol.
Duration: 12 weeks.
Primary outcome: body weight and fat loss.
Greater weight, fat and trunk loss on high dairy versus low calcium, but only seen in adherers to intervention. No effect of high calcium. No No No   Outcomes were study site-specific as seen by site × treatment interactions.
Issues with compliance reduced sample size, particularly in Ohio site.
II Studies with body composition changes as a secondary outcome
Bowen et al. (2005) Adelaide, Australia Study: parallel—high dairy protein/high-Ca (DP, 2400 mg Ca/d) versus high-mixed protein/moderate Ca (MP, 500 mg Ca/d).
Subjects: 50 (30females and 20males) subjects, mean BMI 33.4 kg/m2.
Duration: 12-week energy restriction and 4-weeks energy balance.
Primary outcome: bone resorption during weight loss.
Weight loss during energy restriction was 10% but independent of diet.
Similarly, total fat ↓ by 21.8±1.3% but not different between diets.
Lean body mass did not change in females after weight loss but a small reduction was seen in males (P<0.004); again independent of diet
No No   No  
Jensen et al. (2001) Denmark Study: low-caloric diet—measurement performed after 1 and 3 months. 30 women received 1 g of elemental Ca daily. At 6 months, 24 women from each group were scanned using DXA.
Subjects: 52 women, mean BMI 34.4 kg/m2.
Duration: measurements at 1, 3 and 6 month.
Primary outcome: bone resorption during weight loss.
Diet-induced weight loss is accompanied by bone loss. This can be reduced by supplementing with Ca.
Mean weight loss at 1 month=3.3 and 3.1 kg for untreated group and Ca group, respectively. At 3-month weight loss=2.9 and 2.3 kg, respectively. At 6-month, untreated group regained 1.4 kg and Ca group had no overall weight change.
No Ca group had no overall weight regain
Riedt et al. (2007) USA Study: assigned either normal (1 g/d, n=17) or high- (1.8 g/d, n=14) Ca intake during 6 months of energy restriction (−1200–1500 kcal/d) or were recruited for weight maintenance at 1 g Ca/d intake (n=13). Ca was administered as Ca citrate.
Subjects: 44 pre-menopausal women, mean BMI 27.7 kg/m2.
Duration: 6 months.
Primary Outcome: assess bone loss during weight loss at recommended or higher than recommended calcium intakes in pre-menopausal women.
Significant difference in weight loss between groups (P<0.0001), with high Ca resulting in greater weight loss.
Similar effects for FM (P=0.015) and FFM (P<0.0001) were observed.
Yes↑ Calcium × time interaction with high calcium showing greater weight loss than normal calcium during weight loss
Riedt et al. (2005) USA Study: assigned either normal (1g/d calcium citrate, n=24) or high- (1.8g/d calcium citrate, n=23) Ca intake during 6 months of energy restriction or were recruited for weight maintenance at 1 g Ca/d intake (n=19).
Subjects: 66 postmenopausal women, BMI 27.0 kg/m2.
Duration: 6 months.
Primary Outcome: bone metabolism in obesity.
Women in both weight loss groups lost 9.3±3.9% of initial body weight. No significant difference in weight loss between groups observed.
Similar trends were observed for FM and FFM.
No No No  
Shapses et al. (2004) USA Study: compilation of three parallel, double blind, RCTs of 1000 mg elemental Ca versus placebo.
Subjects: 165 obese post- and pre-menopausal women, mean BMI 33.55 kg/m2.
Duration: 25-week.
Primary outcome: bone metabolism.
No significant differences in body weight or fat change. Magnitude and direction of differences for group means are consistent with hypothesized small effect. No No  
  1. Abbreviations: BW, body weight; Ca, calcium; FFQ, food frequency questionnaire; FM, fat mass as % or kg; FFM, fat-free mass; HC, High dairy calcium; Vit D, vitamin D; WC, waist circumference; WHR, waist-hip ratio.