Calcium in the diet: food sources, recommended intakes, and nutritional bioavailability

Calcium nutritional status among some groups in the United States is suboptimal when judged by calcium intakes and the high prevalence of osteoporosis. Unfortunately, however, it is not clear that increases in calcium intake will have a significant impact on osteoporosis or other chronic diseases that have been linked to calcium nutriture. There is still considerable controversy surrounding the issue of calcium RDAs. The body's ability to adapt to varying levels of calcium intakes, the lack of sensitive indicators of calcium status, and the complexity and slow progression of chronic diseases such as osteoporosis make it very difficult to establish the role of diet in this regard. Great progress has been made in the study of calcium absorption. Much is known about the mechanisms involved in calcium absorption and its regulation. Thus, a rapidly advancing field and further developments will be invaluable to our understanding of the role of diet in calcium nutrition. Calcium bioavailability is affected by diet composition and the chemical form of calcium in foods. The calcium in dairy products is readily absorbed in the intestine. Lactose enhances calcium absorption efficiency under some conditions. Components of plants such as fiber, phytate, and oxalic acid may depress calcium absorption. High intakes of protein increase urinary losses of calcium but this effect may be partially offset by the phosphate association with most high-protein foods. Calcium absorption from salts used in supplement tablets is generally good. Absorption from salts such as calcium carbonate which require acid for dissolution may be poor in persons with achlorhydria unless the tablets are consumed with a meal. The practical significance of factors that may alter calcium bioavailability in normal mixed diets is difficult to assess. It may be a significant factor when calcium intakes are marginal or when absorption by the active transport, vitamin D-dependent process is impaired or not fully developed, i.e., it may be significant when vitamin D status is poor, in the elderly, and in young infants.