Global prevalence of diet low in calcium and the disease burden: results from the Global Burden of Disease Study 2019

BACKGROUND: Due to the essential role of calcium in vital biological functions, diet low in calcium (DLC) is associated with various diseases. However, there is a lack of study about the current prevalence and health burden due to DLC using reliable data sources. METHODS: We used data from the Global Burden of Disease study 2019 (GBD 2019) to estimate the prevalence and health burden of DLC in 204 countries from 1990 to 2019, by age, sex, and sociodemographic index (SDI). The estimates were produced in DisMod-MR 2.1, a Bayesian meta-regression tool. Summary exposure value (SEV) was used to show the prevalence of DLC, while disability adjusted life year (DALY) was used to represent the disease burden. The disease burden was estimated for DLC-induced colorectal cancer. Spearman Rank Order correlation was used for correlation analysis, and estimated annual percentage (EAPC) was used to reflect the temporal trends. RESULTS: From 1990 to 2019, the global prevalence of DLC decreased (EAPC of SEV, -0.47; 95% CI, -0.5 to -0.43), but increased in the Oceania region and in many countries, such as United Arab Emirates, New Zealand, Japan, and France. The global DALYs associated with low calcium were estimated to be 3.14 million (95% UI, 2.25-4.26 million) in 2019, with an age-standardized rate of 38.2 (95% UI, 27.2-51.8) per 100,000. Unlike the prevalence, the global age-standardized DALY rates remained unchanged (EAPC, -0.03; 95% CI, -0.12 to 0.07), but increased in over 80 of the 204 countries, mainly in Asia, Africa, and South America. In all years and regions, the age-standardized SEV and DALY rates were higher in males than in females. The prevalence (rho = -0.823; P < 0.001) and disease burden (rho = -0.433; P < 0.001) associated with DLC were strongly inversely correlated with SDI. The prevalence decreased with age, but the DALY rates increased with age and peaked at about 90 years. The prevalence of DLC has decreased worldwide and in most countries, but the disease burden of DLC-induced colorectal cancer has increased in over 40% of countries worldwide. CONCLUSION: Countries with low sociodemographic level and male people are more likely to experience the risk of DLC and related disease burden. Related measures to improve dietary calcium intake are needed to address DLC-related health problems.