Sun Hongbing, Weaver Connie M
Department of Earth and Chemistry, Rider University, Lawrenceville, NJ, United States.
School of Exercise & Nutritional Sciences, San Diego State University, San Diego, CA, United States.
Am J Clin Nutr. 2025 Jul;122(1):315-323. doi: 10.1016/j.ajcnut.2025.05.018. Epub 2025 May 21.
The relationship among dietary patterns, calcium bioavailability, and bone health in United States adults remains unclear.
This study aims to examine associations among dietary calcium, phytate, and oxalate intake and calcium bioavailability and bone health indicators, including bone mineral density (BMD), osteoporosis prevalence, and fracture incidence.
A serial cross-sectional analysis was conducted using National Health and Nutrition Examination Survey (NHANES) data (1999-2023) for adults aged 18-85. Serum calcium and BMD were measured in NHANES laboratories; dietary intake, osteoporosis, and fracture history were self-reported. Primary exposures included dietary calcium, phytate, and oxalate; outcomes included estimated calcium absorption, and changes in BMD, osteoporosis, and fractures. Survey-weighted regression models were used to assess temporal changes and associations across survey cycles.
In 2017-2020, mean phytate intake was significantly higher than in 1999-2000 (834.1 ± 26.2 mg/d compared with 593.5±23.2 mg/d), and oxalate intake increased from 241.5 ± 6.6 mg/d to 280.5 ± 6.6 mg/d. Calcium intake peaked at 1025.3 ± 9.7 mg/d in 2009-2010 but lowered to 899.9 ± 15.7 mg/d by 2021-2023. Periods of lower calcium intake and higher phytate and oxalate concentrations corresponded with reduced calcium absorption. Milk consumption, a primary source of bioavailable calcium, decreased from 0.95 ± 0.03 cup-equivalents/d in 1999-2000 to 0.56 ± 0.02 in 2017-2020. Serum calcium concentrations lowered from 9.46 ± 0.02 mg/dL in 2009-2010 to 9.29 ± 0.01 mg/dL in 2017-2020. BMD at the femur dropped from 0.982 ± 0.004 to 0.934 ± 0.005 g/cm, and at the femoral neck from 0.849 ± 0.003 to 0.775 ± 0.005 g/cm between 2009-2010 and 2017-2020. Osteoporosis prevalence increased, and fractures at the hip, wrist, and spine were more frequently reported in 2017-2020 compared with those in 2009-2010.
Diets with greater phytate and oxalate and lower calcium and dairy intake may contribute to reduced calcium bioavailability and unfavorable bone health outcomes among United States adults.
美国成年人的饮食模式、钙生物利用度和骨骼健康之间的关系仍不明确。
本研究旨在探讨膳食钙、植酸盐和草酸盐摄入量与钙生物利用度及骨骼健康指标之间的关联，这些指标包括骨矿物质密度（BMD）、骨质疏松症患病率和骨折发生率。
使用国家健康和营养检查调查（NHANES）（1999 - 2023年）中18 - 85岁成年人的数据进行系列横断面分析。血清钙和骨密度在NHANES实验室进行测量；饮食摄入量、骨质疏松症和骨折病史通过自我报告获取。主要暴露因素包括膳食钙、植酸盐和草酸盐；结果包括估计的钙吸收以及骨密度、骨质疏松症和骨折的变化。采用调查加权回归模型来评估不同调查周期之间的时间变化和关联。
在2017 - 2020年，平均植酸盐摄入量显著高于1999 - 2000年（分别为834.1±26.2毫克/天和593.5±23.2毫克/天），草酸盐摄入量从241.5±6.6毫克/天增加到280.5±6.6毫克/天。钙摄入量在2009 - 2010年达到峰值，为1025.3±9.7毫克/天，但到2021 - 2023年降至899.9±15.7毫克/天。钙摄入量较低以及植酸盐和草酸盐浓度较高的时期与钙吸收减少相对应。作为生物可利用钙的主要来源，牛奶消费量从1999 - 2000年的0.95±0.03杯当量/天降至2017 - 2020年的0.56±0.02杯当量/天。血清钙浓度从2009 - 2010年的9.46±0.02毫克/分升降至2017 - 2020年的9.29±0.01毫克/分升。2009 - 2010年至2017 - 2020年期间，股骨骨密度从0.982±0.004降至0.934±0.005克/平方厘米，股骨颈骨密度从0.849±0.003降至0.775±0.005克/平方厘米。与2009 - 2010年相比，2017 - 2020年骨质疏松症患病率增加，髋部、腕部和脊柱骨折报告更为频繁。
植酸盐和草酸盐含量较高、钙和乳制品摄入量较低的饮食可能导致美国成年人钙生物利用度降低以及骨骼健康状况不佳。
