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Dietary calcium intake and hypertension risk: a dose–response meta-analysis of prospective cohort studies

European Journal of Clinical Nutrition volume 73, pages 969–978 (2019)Cite this article

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Abstract

The association of calcium intake with risk of developing hypertension in the general population has not been established yet. We systematically searched PubMed and Scopus databases up to February 2018 to find prospective observational studies investigating the association of calcium intake with risk of developing hypertension. The reported risk estimates were pooled using a random-effects model. Eight prospective cohort studies (248,398 participants and 30,838 cases) were included. Seven studies measured dietary calcium intake, but one study measured total calcium intake (calcium from food and supplements). A significant inverse association was found for the highest versus lowest category of calcium intake (relative risk: 0.89, 95%CI: 0.86, 0.93; I2 = 0%, n = 8), and for each 500 mg/d increment (relative risk: 0.93, 95%CI: 0.90, 0.97; I2 = 64%, n = 7). Summary results were the same with the main analyses when the analyses were restricted only to dietary calcium intake. A nonlinear dose–response meta-analysis exhibited a linear inverse association, with a somewhat steeper trend within the low and moderate intakes. In conclusion, higher dietary calcium intake, independent of adiposity and intake of other blood pressure-related minerals, is slightly associated with a lower risk of developing hypertension.

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References

  1. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017;317:165–82.

    Article  Google Scholar 

  2. Chockalingam A, Campbell NR, Fodor JG. Worldwide epidemic of hypertension. Can J Cardiol. 2006;22:553–5.

    Article  Google Scholar 

  3. Lewanczuk R. Hypertension as a chronic disease: what can be done at a regional level? Can J Cardiol. 2008;24:483–4.

    Article  Google Scholar 

  4. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347–60.

    Article  Google Scholar 

  5. Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the US by improvements in use of clinical preventive services. Am J Prev Med. 2010;38:600–9.

    Article  Google Scholar 

  6. Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR, et al. Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension. 2004;43:10–17.

    Article  CAS  Google Scholar 

  7. Whelton PK, He J, Appel LJ, Cutler JA, Havas S, Kotchen TA, et al. Primary prevention of hypertension: clinical and public health advisory from The National High Blood Pressure Education Program. JAMA. 2002;288:1882–8.

    Article  Google Scholar 

  8. Engberink MF, Geleijnse JM, de Jong N, Smit HA, Kok FJ, Verschuren WM. Dairy intake, blood pressure, and incident hypertension in a general Dutch population. J Nutr. 2009;139:582–7.

    Article  CAS  Google Scholar 

  9. Garcia-Palmieri MR, Costas R Jr, Cruz-Vidal M, Sorlie PD, Tillotson J, Havlik RJ. Milk consumption, calcium intake, and decreased hypertension in Puerto Rico. Puerto Rico Heart Health Program study. Hypertension. 1984;6:322–8.

    Article  CAS  Google Scholar 

  10. Psaltopoulou T, Naska A, Orfanos P, Trichopoulos D, Mountokalakis T, Trichopoulou A. Olive oil, the Mediterranean diet, and arterial blood pressure: the Greek European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr. 2004;80:1012–8.

    Article  CAS  Google Scholar 

  11. Ruidavets JB, Bongard V, Simon C, Dallongeville J, Ducimetiere P, Arveiler D, et al. Independent contribution of dairy products and calcium intake to blood pressure variations at a population level. J Hypertens. 2006;24:671–81.

    Article  CAS  Google Scholar 

  12. Snijder MB, van der Heijden AA, van Dam RM, Stehouwer CD, Hiddink GJ, Nijpels G, et al. Is higher dairy consumption associated with lower body weight and fewer metabolic disturbances? The Hoorn Study. Am J Clin Nutr. 2007;85:989–95.

    Article  CAS  Google Scholar 

  13. Wang H, Fox CS, Troy LM, McKeown NM, Jacques PF. Longitudinal association of dairy consumption with the changes in blood pressure and the risk of incident hypertension: the Framingham Heart Study. Br J Nutr. 2015;114:1887–99.

    Article  CAS  Google Scholar 

  14. McGrane MM, Essery E, Obbagy J, Lyon J, Macneil P, Spahn J, et al. Dairy consumption, blood pressure, and risk of hypertension: an evidence-based review of recent literature. Curr Cardiovasc Risk Rep. 2011;5:287–98.

    Article  Google Scholar 

  15. Cappuccio F, Elliott P, Allender P, Pryer J, Follman D, Cutler J. Epidemiologic association between dietary calcium intake and blood pressure: a meta-analysis of published data. Am J Epidemiol. 1995;142:935–45.

    Article  CAS  Google Scholar 

  16. Pryer J, Cappuccio F, Elliott P. Dietary calcium and blood pressure: a review of the observational studies. J Human Hypertens. 1995;9:597–604.

    CAS  Google Scholar 

  17. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred Reporting Items for Systematic Reviews and Meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

    Article  Google Scholar 

  18. Alonso A, Beunza JJ, Delgado-Rodriguez M, Martinez JA, Martinez-Gonzalez MA. Low-fat dairy consumption and reduced risk of hypertension: the Seguimiento Universidad de Navarra (SUN) cohort. Am J Clin Nutr. 2005;82:972–9.

    Article  CAS  Google Scholar 

  19. Camoes M, Oliveira A, Pereira M, Severo M, Lopes C. Role of physical activity and diet in incidence of hypertension: a population-based study in Portuguese adults. Eur J Clin Nutr. 2010;64:1441–9.

    Article  CAS  Google Scholar 

  20. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.

    Article  Google Scholar 

  21. Schwingshackl L, Knüppel S, Schwedhelm C, Hoffmann G, Missbach B, Stelmach-Mardas M, et al. Perspective: NutriGrade: a scoring system to assess and judge the meta-evidence of randomized controlled trials and cohort studies in nutrition research. Adv Nutr. 2016;7:994–1004.

    Article  Google Scholar 

  22. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  Google Scholar 

  23. Dwyer JH, Li L, Dwyer KM, Curtin LR, Feinleib M. Dietary calcium, alcohol, and incidence of treated hypertension in the NHANES I epidemiologic follow-up study. Am J Epidemiol. 1996;144:828–38.

    Article  CAS  Google Scholar 

  24. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  Google Scholar 

  25. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.

    Article  CAS  Google Scholar 

  26. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.

    Article  CAS  Google Scholar 

  27. Berlin JA, Longnecker MP, Greenland S. Meta-analysis of epidemiologic dose-response data. Epidemiology. 1993;4:218–28.

    Article  CAS  Google Scholar 

  28. Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose-response data. Stata J. 2006;6:40.

    Article  Google Scholar 

  29. Schwingshackl L, Schwedhelm C, Hoffmann G, Lampousi AM, Knuppel S, Iqbal K, et al. Food groups and risk of all-cause mortality: a systematic review and meta-analysis of prospective studies. Am J Clin Nutr. 2017;105:1462–73.

    CAS  PubMed  Google Scholar 

  30. Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D. Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2011;175:66–73.

    Article  Google Scholar 

  31. Ascherio A, Rimm EB, Giovannucci EL, Colditz GA, Rosner B, Willett WC, et al. A prospective study of nutritional factors and hypertension among US men. Circulation. 1992;86:1475–84.

    Article  CAS  Google Scholar 

  32. Lelong H, Blacher J, Baudry J, Adriouch S, Galan P, Fezeu L, et al. Individual and combined effects of dietary factors on risk of incident hypertension: prospective analysis from the NutriNet-Sante Cohort. Hypertension. 2017;70:712–20.

    Article  CAS  Google Scholar 

  33. Talaei M, et al. Dairy Food Intake Is Inversely Associated with Risk of Hypertension: The Singapore Chinese Health Study, 2.J Nutr. 2016;147:235–41.

    Article  Google Scholar 

  34. Wang L, Manson JE, Buring JE, Lee IM, Sesso HD. Dietary intake of dairy products, calcium, and vitamin D and the risk of hypertension in middle-aged and older women. Hypertension. 2008;51:1073–9.

    Article  CAS  Google Scholar 

  35. Witteman JC, Willett WC, Stampfer MJ, Colditz GA, Sacks FM, Speizer FE, et al. A prospective study of nutritional factors and hypertension among US women. Circulation. 1989;80:1320–7.

    Article  CAS  Google Scholar 

  36. Ralston RA, Lee JH, Truby H, Palermo CE, Walker KZ. A systematic review and meta-analysis of elevated blood pressure and consumption of dairy foods. J Hum Hypertens. 2012;26:3–13.

    Article  CAS  Google Scholar 

  37. Soedamah-Muthu SS, Verberne LD, Ding EL, Engberink MF, Geleijnse JM. Dairy consumption and incidence of hypertension: a dose-response meta-analysis of prospective cohort studies. Hypertension. 2012;60:1131–7.

    Article  CAS  Google Scholar 

  38. Zemel MB. Calcium modulation of hypertension and obesity: mechanisms and implications. J Am Coll Nutr. 2001;20:428S–435S. discussion 440S-2S

    Article  CAS  Google Scholar 

  39. Bohr DF. Vascular smooth muscle: dual effect of calcium. Science. 1963;139:597–9.

    Article  CAS  Google Scholar 

  40. Zemel MB. Nutritional and endocrine modulation of intracellular calcium: implications in obesity, insulin resistance and hypertension. Mol Cell Biochem. 1998;188:129–36.

    Article  CAS  Google Scholar 

  41. Zemel MB. Regulation of adiposity and obesity risk by dietary calcium: mechanisms and implications. J Am Coll Nutr. 2002;21:146s–151s.

    Article  CAS  Google Scholar 

  42. Touyz RM, Panz V, Milne FJ. Relations between magnesium, calcium, and plasma renin activity in black and white hypertensive patients. Miner Electrolyte Metab. 1995;21:417–22.

    CAS  PubMed  Google Scholar 

  43. Zhang R, Zhu W, Du X, Xin J, Xue Y, Zhang Y, et al. S100A16 mediation of weight gain attenuation induced by dietary calcium. Metabolism. 2012;61:157–63.

    Article  CAS  Google Scholar 

  44. Van Loan M. The role of dairy foods and dietary calcium in weight management. J Am Coll Nutr. 2009;28(Suppl 1):120s–129s.

    Article  Google Scholar 

  45. dos Santos LC, de Padua Cintra I, Fisberg M, Martini LA. Calcium intake and its relationship with adiposity and insulin resistance in post-pubertal adolescents. J Hum Nutr Diet. 2008;21:109–16.

    Article  Google Scholar 

  46. Ma B, Lawson AB, Liese AD, Bell RA, Mayer-Davis EJ. Dairy, magnesium, and calcium intake in relation to insulin sensitivity: approaches to modeling a dose-dependent association. Am J Epidemiol. 2006;164:449–58.

    Article  Google Scholar 

  47. Wang F, Han L, Hu D. Fasting insulin, insulin resistance and risk of hypertension in the general population: a meta-analysis. Clin Chim Acta. 2017;464:57–63.

    Article  CAS  Google Scholar 

  48. Rozenberg S, Body J-J, Bruyère O, Bergmann P, Brandi ML, Cooper C, et al. Effects of dairy products consumption on health: benefits and beliefs—a commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. Calcif Tissue Int. 2016;98:1–17.

    Article  CAS  Google Scholar 

  49. Wang Y, Li S. Worldwide trends in dairy production and consumption and calcium intake: is promoting consumption of dairy products a sustainable solution for inadequate calcium intake? Food Nutr Bull. 2008;29:172–85.

    Article  Google Scholar 

  50. Chmielewski Jennifer, J. Bryan Carmody. Dietary sodium, dietary potassium, and systolic blood pressure in US adolescents.J Clin Hypertens. 2017;19:904–9.

    Article  CAS  Google Scholar 

  51. Ndanuko RN, Tapsell LC, Charlton KE, Neale EP, O’Donnell KM, Batterham MJ. Relationship between sodium and potassium intake and blood pressure in a sample of overweight adults. Nutrition. 2017;33:285–90.

    Article  CAS  Google Scholar 

  52. Zhang Z, Cogswell ME, Gillespie C, Fang J, Loustalot F, Dai S, et al. Association between usual sodium and potassium intake and blood pressure and hypertension among U.S. adults: NHANES 2005-10. PLoS One. 2013;8:e75289.

    Article  CAS  Google Scholar 

  53. FitzGerald RJ, Murray BA, Walsh DJ. Hypotensive peptides from milk proteins. J Nutr. 2004;134:980s–988s.

    Article  CAS  Google Scholar 

  54. Larsson SC, Orsini N, Wolk A. Dietary calcium intake and risk of stroke: a dose-response meta-analysis. Am J Clin Nutr. 2013;97:951–7.

    Article  CAS  Google Scholar 

  55. Gueguen L, Pointillart A. The bioavailability of dietary calcium. J Am Coll Nutr. 2000;19:119s–136s.

    Article  CAS  Google Scholar 

  56. Allender PS, Cutler JA, Follmann D, Cappuccio FP, Pryer J, Elliott P. Dietary calcium and blood pressure: a meta-analysis of randomized clinical trials. Ann Intern Med. 1996;124:825–31.

    Article  CAS  Google Scholar 

  57. Griffith LE, Guyatt GH, Cook RJ, Bucher HC, Cook DJ. The influence of dietary and nondietary calcium supplementation on blood pressure: an updated metaanalysis of randomized controlled trials. Am J Hypertens. 1999;12:84–92.

    Article  CAS  Google Scholar 

  58. Wang X, Chen H, Ouyang Y, Liu J, Zhao G, Bao W, et al. Dietary calcium intake and mortality risk from cardiovascular disease and all causes: a meta-analysis of prospective cohort studies. BMC Med. 2014;12:158.

    Article  Google Scholar 

  59. Butler LM, Wong AS, Koh WP, Wang R, Yuan JM, Yu MC. Calcium intake increases risk of prostate cancer among Singapore Chinese. Cancer Res. 2010;70:4941–8.

    Article  CAS  Google Scholar 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

Research idea and study design: A.J., M.S.Z.; data acquisition: A.J., M.S.Z.; data analysis/interpretation: A.J., M.S.Z.; statistical analysis: A.J., supervision: A.J., A.J. is the guarantor. All authors have read and approved the final manuscript. All authors had full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis.

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  1. Food (Salt) Safety Research Center, Semnan University of Medical Sciences, Semnan, Iran

    Ahmad Jayedi

  2. Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran

    Mahdieh Sadat Zargar

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  1. Ahmad Jayedi
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Correspondence to Ahmad Jayedi.

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Jayedi, A., Zargar, M.S. Dietary calcium intake and hypertension risk: a dose–response meta-analysis of prospective cohort studies. Eur J Clin Nutr 73, 969–978 (2019). https://doi.org/10.1038/s41430-018-0275-y

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