© Borgis - Postępy Nauk Medycznych 10/2016, s. 777-780
Maja Warzecha1, 2, *Edward Czerwiński1, 3
Calcium consumption in diet of elderly patients – literature review
Spożycie wapnia z dietą u osób starszych – przegląd literatury
1Department of Bone and Joint Diseases, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków
Head of Department: Professor Edward Czerwiński, MD, PhD
2Department of Sports Medicine and Human Nutrition, University School of Physical Education in Kraków
Head of Department: Professor Zbigniew Szyguła, MD, PhD
Doctoral Student: Maja Warzecha, MSc
Assistant: Maja Warzecha, MSc
3Kraków Medical Center
Head of Center: Professor Edward Czerwiński, MD, PhD
Streszczenie
Dla osób starszych bądź znajdujących się w grupie ryzyka osteoporozy ważne jest racjonalne żywienie. Szczególną uwagę zwraca się na odpowiednią podaż soli wapnia i witaminy D. Niedobory tych składników mają wpływ na utratę masy kostnej i mogą zwiększać ryzyko złamania osteoporotycznego. Dokonano przeglądu literatury celem zobrazowania problemu niedoborów wapnia w diecie u osób w starszym wieku oraz u osób po złamaniach osteoporotycznych. Dane literaturowe dotyczące podaży wapnia z dietą wskazują obniżone wartości spożycia tego pierwiastka względem wartości referencyjnych na całym świecie, zarówno w przypadku osób starszych, jak i u osób po złamaniach osteoporotycznych. Wśród osób starszych najniższe spożycie tego pierwiastka stwierdzono wśród mieszkańców Azji. Natomiast u osób po złamaniach osteoporotycznych podaż tego pierwiastka w Europie, Północnej Ameryce oraz Azji nie przekracza poziomu 1000 mg/dzień, co oznacza jeszcze większe niedobory niż w przypadku osób w starszym wieku bez złamań. Dane te wskazują na potrzebę edukacji pacjentów w zakresie odpowiedniego żywienia w leczeniu i profilaktyce osteoporozy. Warto również rozważyć podjęcie suplementacji diety wapniem w populacjach szczególnie narażonych na niedobory.
Summary
Rational nutrition is particularly important for the elderly or those at risk of osteoporosis. Special attention is paid to an adequate intake of calcium and vitamin D. Deficiencies of these nutrients affect bone loss and can increase the risk of osteoporotic fracture. A literature review was done in order to illustrate the problem of calcium deficiency in the diet of the elderly and of patients who had sustained osteoporotic fractures. The data found in the literature show that the calcium intake is reduced for both the elderly and people with osteoporotic fractures as far as the reference values throughout the world are taken into account. Among the elderly the lowest intake of this element is found among Asians. What is more, in the case of patients who had suffered from osteoporotic fractures the supply of this element in Europe, North America and Asia does not exceed 1000 mg/day, which indicates even greater shortages than in the elderly without fractures. The data indicate the need for patient education in the field of adequate nutrition in case of the treatment and prevention of osteoporosis. Also calcium supplementation must be considered in populations especially exposed to deficiency.
Introduction
Proper nutrition based on an adequate supply of nutrients directly affects health. Improper nutrition, a diet with deficiency or excess of essential nutrients may be one of the factors affecting the development of osteoporosis. Proper nutrition and proper supplementation can delay a number of involutional changes in the body which comes with age. Daily consumption of a proper amount of calcium, vitamin D, potassium and magnesium should be particularly stressed in dietary recommendations for the elderly (1). Research conducted among 90 individuals with osteoporosis by Zhao et al. illustrated that the group which was educated about proper nutrition and applied this knowledge showed a significant (p < 0.05) improvement in the results of spine and femoral neck BDM (2). Due to that fact, the appropriate amount of calcium and vitamin D may directly lessen the loss of calcium from bones caused by aging process, reducing the risk of osteoporosis and also reduce the risk of osteoporotic fractures in the case of the elderly (3). The aim of the literature review was to illustrate the problem of not consuming the recommended amount of calcium in the diet of the elderly and people who had suffered from osteoporotic fractures.
Effectiveness of the calcium intake for the elderly
Calcium is one of the basic inorganic constituents present in a human body. The total body calcium is approximately 1-2% of a body weight. The vast majority of total body calcium (> 99%) is located in bone tissue (4). About 30% of the ingested calcium is absorbed in the small intestine; the rest is transformed to the large intestine where another 10% is absorbed. To sum up, 60% of the calcium supplied by everyday diet is excreted in the feces (5). Due to the large loss of calcium, it is important to provide an appropriate supply of this element with the diet or by supplementation if necessary. The effectiveness of calcium supplementation in the case of osteoporotic patients showed positive results in the change of BMD in a group of 1,806 postmenopausal women (2.05% skeletal system in general, 1.66% lumbar spine, 1.6% hip, 1.9% radius) (6). It is increasingly recommended to supplement calcium and vitamin D simultaneously as shown in studies carried out, inter alia, by Tang et al. (7). They recommend this pattern of supplementation to postmenopausal women and men over the age of 65 and confirmed the assumption that the supply of 1,200 mg/day of calcium alone or together with vitamin D (800 IU/day), reduces the risk of osteoporotic fractures (7).
Recommended calcium intake in a daily diet
Deficiencies of calcium are seen as nutritional risk factors as far as osteoporosis is concerned (8). Recommendations for its consumption, in the case of people over the age of 50, are slightly different for man and women. The recommended dose of calcium for women is 1200 mg/day while men should consume 1000 mg/day. At the age of 70, both groups should provide their organisms with 1200 mg/day (9). The value recommended for different age groups and genders is illustrated below (tab. 1).
Tab. 1. Recommendation of dietary calcium intake (9)
| Age | Male [mg] | Female [mg] | Pregnant [mg] | Lactating [mg] |
| 0-6 months | 200 | 200 | | |
| 7-12 months | 260 | 260 | | |
| 1-3 years | 700 | 700 | | |
| 4-8 years | 1000 | 1000 | | |
| 9-13 years | 1300 | 1300 | | |
| 14-18 years | 1300 | 1300 | 1300 | 1300 |
| 19-50 years | 1000 | 1000 | 1000 | 1000 |
| 51-70 years | 1000 | 1200 | | |
| > 71 years | 1200 | 1200 | | |
It is possible to assess calcium deficiency on the basis of blood serum. It occurs when the amount of calcium is lower than 84 mg/l (normal range 84-104 mg/l) which largely depends on the contents of calcium in a diet, absorption in the gastrointestinal tract, tubular reabsorption and calcium build-up in bones (10).
Deficiencies of calcium in the diet of the elderly people
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