Department of Surgical Sciences, Section of Orthopedics, Uppsala University, SE-751 85 Uppsala, Sweden.
BMJ. 2013 Feb 12;346:f228. doi: 10.1136/bmj.f228.
To investigate the association between long term intake of dietary and supplemental calcium and death from all causes and cardiovascular disease.
Prospective longitudinal cohort study.
Swedish mammography cohort, a population based cohort established in 1987-90.
61 433 women (born between 1914 and 1948) followed-up for a median of 19 years.
Primary outcome measures, identified from registry data, were time to death from all causes (n=11 944) and cause specific cardiovascular disease (n=3862), ischaemic heart disease (n=1932), and stroke (n=1100). Diet was assessed by food frequency questionnaires at baseline and in 1997 for 38 984 women, and intakes of calcium were estimated. Total calcium intake was the sum of dietary and supplemental calcium.
The risk patterns with dietary calcium intake were non-linear, with higher rates concentrated around the highest intakes (≥1400 mg/day). Compared with intakes between 600 and 1000 mg/day, intakes above 1400 mg/day were associated with higher death rates from all causes (hazard ratio 1.40, 95% confidence interval 1.17 to 1.67), cardiovascular disease (1 49, 1.09 to 2.02), and ischaemic heart disease (2.14, 1.48 to 3.09) but not from stroke (0.73, 0.33 to 1.65). After sensitivity analysis including marginal structural models, the higher death rate with low dietary calcium intake (<600 mg/day) or with low and high total calcium intake was no longer apparent. Use of calcium tablets (6% users; 500 mg calcium per tablet) was not on average associated with all cause or cause specific mortality but among calcium tablet users with a dietary calcium intake above 1400 mg/day the hazard ratio for all cause mortality was 2.57 (95% confidence interval 1.19 to 5.55).
High intakes of calcium in women are associated with higher death rates from all causes and cardiovascular disease but not from stroke.
研究长期摄入膳食和补充钙与全因死亡和心血管疾病的关系。
前瞻性纵向队列研究。
瑞典乳腺摄影队列，这是一个 1987-90 年建立的基于人群的队列。
61433 名女性（出生于 1914 年至 1948 年之间），中位随访时间为 19 年。
主要观察指标通过登记数据确定，分别为全因死亡（n=11944）和特定病因心血管疾病（n=3862）、缺血性心脏病（n=1932）和中风（n=1100）的时间。在基线和 1997 年，通过食物频率问卷评估了饮食，并且估算了钙的摄入量。总钙摄入量是膳食和补充钙的总和。
膳食钙摄入量的风险模式呈非线性，较高的死亡率集中在最高摄入量（≥1400mg/天）周围。与 600-1000mg/天的摄入量相比，1400mg/天以上的摄入量与全因死亡率（危险比 1.40，95%置信区间 1.17-1.67）、心血管疾病（1.49，1.09-2.02）和缺血性心脏病（2.14，1.48-3.09）升高相关，但与中风（0.73，0.33-1.65）无关。在包括边际结构模型的敏感性分析后，低膳食钙摄入量（<600mg/天）或低和高总钙摄入量与低死亡率不再相关。钙片的使用（6%的使用者；每片 500mg 钙）平均与全因或特定病因死亡率无关，但在钙片使用者中，当膳食钙摄入量超过 1400mg/天时，全因死亡率的危险比为 2.57（95%置信区间 1.19-5.55）。
女性摄入高钙与全因死亡率和心血管疾病相关，但与中风无关。
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