Cappuccio F P, Elliott P, Allender P S, Pryer J, Follman D A, Cutler J A
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, England, United Kingdom.
Am J Epidemiol. 1995 Nov 1;142(9):935-45. doi: 10.1093/oxfordjournals.aje.a117741.
The objectives of the study were to assess whether the epidemiologic data support a relation between dietary calcium intake and blood pressure, to obtain a quantitative estimate of the difference in blood pressure for a given difference in dietary calcium intake, and to assess the public health implications. A meta-analysis of published data (January 1983 to November 1993) that investigated the association between dietary calcium intake and blood pressure in different populations around the world was performed. Of 63 population studies identified, 23 were suitable for a quantitative overview (total n = 38,950). Unadjusted regression coefficients (95% confidence intervals) were obtained. Pooled unadjusted regression coefficients (95% confidence intervals) were then computed weighting each individual study by the inverse of its variance. Tests of heterogeneity and sensitivity analysis were carried out, and the possibility of publication bias was assessed. The regression coefficients ranged between -9.40 and 1.63 mmHg/100 mg calcium for systolic blood pressure and between -4.90 and 0.47 for diastolic blood pressure. In men (11 studies, n = 7,271), the pooled regression coefficients were -0.010 and -0.009 mmHg/100 mg calcium for systolic and diastolic pressures, respectively (p < 0.001 and p < 0.05). In women (six studies, n = 8,507), they were -0.15 and -0.057 mmHg/100 mg calcium (p < 0.001 and p < 0.02), and in men and women combined (six studies, n = 23,172 for systolic pressure and four studies, n = 3,215 for diastolic pressure) they were -0.061 and -0.061 mmHg/100 mg calcium (p < 0.001 and p < 0.05). In those studies that used the 24-hour recall method, the pooled regression coefficients were -0.06 and -0.09 mmHg/100 mg calcium (p < 0.005 and p = 0.07), whereas in those that used the food frequency questionnaire, they were -0.15 and -0.05 mmhg/100 mg calcium (p < 0.001 and p < 0.03). These data are consistent with an inverse association between dietary calcium intake and blood pressure. However, the size of the estimate, the observed heterogeneity among studies, and the possibility of confounding and publication bias indicate that an increase in calcium intake above the Recommended Dietary Allowance is not recommended at population level for the prevention and treatment of high blood pressure.
该研究的目的是评估流行病学数据是否支持膳食钙摄入量与血压之间的关系，对给定膳食钙摄入量差异时的血压差异进行定量估计，并评估其对公共卫生的影响。我们对1983年1月至1993年11月发表的关于世界各地不同人群膳食钙摄入量与血压之间关联的数据进行了荟萃分析。在确定的63项人群研究中，23项适合进行定量综述（总计n = 38,950）。获得了未调整的回归系数（95%置信区间）。然后计算合并的未调整回归系数（95%置信区间），以每项研究方差的倒数为权重对其进行加权。进行了异质性检验和敏感性分析，并评估了发表偏倚的可能性。收缩压的回归系数在-9.40至1.63 mmHg/100 mg钙之间，舒张压的回归系数在-4.90至0.47之间。在男性中（11项研究，n = 7,271），收缩压和舒张压的合并回归系数分别为-0.010和-0.009 mmHg/100 mg钙（p < 0.001和p < 0.05）。在女性中（6项研究，n = 8,507），分别为-0.15和-0.057 mmHg/100 mg钙（p < 0.001和p < 0.02），在男性和女性合并的情况中（收缩压6项研究，n = 23,172；舒张压4项研究，n = 3,215），分别为-0.061和-0.061 mmHg/100 mg钙（p < 0.001和p < 0.05）。在那些使用24小时回忆法的研究中，合并回归系数为-0.06和-0.09 mmHg/100 mg钙（p < 0.005和p = 0.07），而在那些使用食物频率问卷的研究中，分别为-0.15和-0.05 mmHg/100 mg钙（p < 0.001和p < 0.03）。这些数据与膳食钙摄入量和血压之间的负相关关系一致。然而，估计值的大小、研究中观察到的异质性以及混杂和发表偏倚的可能性表明，在人群层面不建议为预防和治疗高血压而将钙摄入量增加到高于推荐膳食摄入量的水平。
