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Abstract
Several epidemiological studies investigated the relation of Ca intake with type 2 diabetes mellitus (T2DM), but there were inconsistencies in their findings. So, we conducted a systematic review and dose–response meta-analysis to quantify the relation of dietary Ca intake with the risk of T2DM/hyperglycemia in adults. A systematic search was conducted up to May 2021, in MEDLINE (Pubmed), Web of Science (WOS), Scopus electronic databases and Google Scholar, for epidemiological studies that investigated the relation of dietary Ca intake (as the exposure) and T2DM/hyperglycemia (as the outcome) in adults, without restriction in publication date and language. Finally, 8 cohort and 9 cross-sectional studies were included in the analysis. The body of evidence was assessed by the GRADE approach. Combining effect sizes from prospective cohort studies included 255,744 general adult population illustrated that highest level of dietary Ca intake, compared to lowest category, was related to an 18% reduced risk of T2DM (RR: 0.82; 95% CI 0.74–0.92). Based on linear dose–response analysis (including 255,744 healthy individuals and 13,531 patients with T2DM), each 300, 600 and 1000 mg/day increment in dietary Ca intake was respectively associated to 7, 14 and 23% reduced risk of T2DM. There was a steeper reduction in risk of T2DM when dietary Ca intake increased from low levels to 750 mg/day. Nevertheless, meta-analysis of cross-sectional studies revealed an inverse significant association between dietary Ca intake and T2DM/hyperglycemia only in the female population (OR: 0.66; 95% CI 0.50–0.88). This meta-analysis illustrated an inverse association between dietary Ca intake and risk of T2DM in general adult populations in prospective cohort studies, in a dose–response manner. It seems that increasing dietary Ca intake from low levels to around 750 mg/day was inversely related to risk of T2DM. In cross-sectional studies, an inverse relation between dietary Ca intake and T2DM/hyperglycemia was found only in females.
Highlights
Several epidemiological studies investigated the relation of Ca intake with type 2 diabetes mellitus (T2DM), but there were inconsistencies in their findings
Abbreviations odds ratios (ORs) Odds ratio reduced risk of T2DM (RR) Relative risks 95% confidence intervals (CIs) 95% Confidence intervals; hazard ratios (HR), Hazard ratio; β Standard regression coefficient B Un-standard regression coefficient T2DM Type 2 diabetes mellitus cardiovascular diseases (CVD) Cardiovascular disease PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline NOS Newcastle–Ottawa scale
Intake of this nutrient could change the risk of stroke7, CVD8, colorectal and prostate cancer[9], multiple sclerosis[10], psoriasis, impaired glucose tolerance, insulin resistance, hyperglycemia and T2DM11
Summary
Several epidemiological studies investigated the relation of Ca intake with type 2 diabetes mellitus (T2DM), but there were inconsistencies in their findings. We conducted a systematic review and dose–response meta-analysis to quantify the relation of dietary Ca intake with the risk of T2DM/ hyperglycemia in adults. Meta-analysis of cross-sectional studies revealed an inverse significant association between dietary Ca intake and T2DM/hyperglycemia only in the female population (OR: 0.66; 95% CI 0.50–0.88). This meta-analysis illustrated an inverse association between dietary Ca intake and risk of T2DM in general adult populations in prospective cohort studies, in a dose–response manner. It seems that increasing dietary Ca intake from low levels to around 750 mg/ day was inversely related to risk of T2DM. A recent systematic review has suggested that Ca supplementation might have protective effects on low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) in overweight and obese s ubjects[12]
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