Calcium Intake of the U.S. Population, WWEIA/NHANES 2009-2010

Highlights

Food Surveys Research Group

Dietary Data Brief No.

U.S. DEPARTMENT OF AGRICULTURE

Agricultural Research Service

Beltsville Human Nutrition Research Center

Food Surveys Research Group

www.ars.usda.gov/ba/bhnrc/fsrg

• The average daily dietary

calcium intake is 1029 mg.

• The diets of females have a

higher calcium density

compared to males.

• A quarter of Americans report

taking a dietary supplement

containing calcium.

• Dietary calcium intake of the

population has shown an

increasing trend from the mid-

90s, increasing approximately

85 to 190 mg across age

groups.

• The top three WWEIA Food

Categories that contribute to

calcium intake are Milk and

dairy, Mixed dishes, and

Grains

September 2014

Calcium intake of the U.S.

population

What We Eat in America, NHANES 2009-2010

Calcium, the most abundant mineral in the body, is required for many important

functions. About 99% of the body’s calcium is found in bones and teeth, where it

is essential for formation and maintenance of strong bones and teeth. The

remaining 1% of calcium is found in the blood, muscle and other tissues, and has

important roles in blood clotting, muscle function, nerve transmission, and blood

pressure. Calcium has been identified as a nutrient of concern in the 2010

Dietary Guidelines for Americans (1). Data from What We Eat In America,

NHANES 2009-2010 indicated that 42% of Americans did not meet their

Estimated Average Requirements for calcium as recommended by the Institute

of Medicine (2). This report presents data on the dietary and supplemental

calcium intake of the U.S. population as reported in What We Eat In America,

NHANES 2009-2010 and the contribution of foods and beverages to calcium

intake.

The mean daily intake of dietary calcium for individuals 2 years and older was

1029 mg. As Figure 1 shows, intake of males was significantly higher than

females for teens and adults up to 60 years of age. For those older adults,

intake was significantly lower than all others combined within gender.

What is the calcium intake of the U.S. population?

Figure 1. Calcium intake of U.S. population, WWEIA, NHANES 2009-2010

1150

1034

1127

1260

1210

1188

966

913

1030

963

948

947

882

842

500

1000

1500

All

2-5

6-11

12-19

20-39

40-59

60+

Age (years)

Males

Females

Calcium (mg)

Significantly different from females (p<0.001)

Within gender, significantly different than other age groups combined (P<0.001)

SOURCE: What We Eat in America, NHANES 2009-2010, day 1, individuals 2+ years

M. Katherine Hoy, EdD, RD and Joseph D. Goldman, MA

FSRG Dietary Data Brief -- No.

13 – September 2014

Calcium intake is influenced by energy intake.

Figure 2. Calcium density (mg/1000 kcal) of U.S. population, WWEIA, NHANES 2009-2010

The higher calcium intake of males is related to their higher energy intakes. When calcium intake is

adjusted by energy intake, the diets of females have a higher calcium density (mg calcium/1000 kcal) than

males, as shown in Figure 2. When all females are considered together, this difference is significant,

although differences between males and females by age group were only significant for those 20-39 years.

Difference in calcium density may be related to food choice.

494

680

587

509

458

470

473

530

682

533

528

518

515

531

100

200

300

400

500

600

700

800

All

2-5

6-11

12-19

20-39

40-59

60+

Males

Females

Age (years)

*Significantly different from males (p<0.001)

SOURCE: What We Eat in America, NHANES 2009-2010, day 1, individuals 2+ years

Calcium (mg)

FSRG Dietary Data Brief -- No.

13 -- September 2014

Does calcium intake differ by race/ethnicity and income status?

Figure 3. Calcium intake of U.S. population, by race/ethnicity and income, WWEIA, NHANES 2009-2010

-2-

1079

977

865

996

992

1078

500

1000

1500

Non-

Hispanic

Black

Hispanic

Low

Middle

High

Race/ethnicity

Income

‡

Calcium (mg)

a,b

Within race/ethnicity and income, significantly different (p<0.001)

‡

Income level based on % poverty threshold – Low: 0-130%; Middle: 131-300%; High: >300%

SOURCE: What We Eat in America, NHANES 2009-2010, day 1, individuals 2+ years

Non-

Hispanic

White

Yes. There are some differences in calcium intakes by race/ethnicity and income status. As Figure 3

shows, mean intake of Non-Hispanic blacks was lower than Non-Hispanic whites and Hispanics. Figure 3

also shows that when considered by income status, those from lower income households had lower intakes

compared with those from the highest income households. Differences in calcium density by

race/ethnicity and income status are similar to those for intake.

FSRG Dietary Data Brief -- No.

13 – September, 2014

Yes. As Figure 4 illustrates, trends in calcium density, excluding calcium that may be obtained from

drinking water, show significant increases since the mid to late 1990s. Across age categories, the

increases ranged from around 70 to 130 mg per 1000 kcal. These increases in calcium density resulted in

similar trends for total calcium intake, which increased around 85 to 190 mg across age categories (data

not shown).

Has calcium intake changed over time?

Figure 4. Trends in calcium density between 1994-1998 and 2009-2010

-3-

538

483

415

376

375

413

667

546

489

449

457

477

500

1000

2-5

6-11

12-19

20-39

40-59

60 and over

Calcium (mg)

Age (years)

1994-1998

1999-2000

2001-2002

2003-2004

2005-2006

2007-2008

2009-2010

Significant linear trend for increasing calcium density between 1994-1998 and 2009-2010 P<0.001

SOURCE: What We Eat in America, NHANES 2009-2010, day 1, individuals 2+ years

FSRG Dietary Data Brief -- No.

13 – September 2014

Approximately one-quarter (26%) of individuals 2 years and older (excluding pregnant and/or lactating

women, and breast-fed children) reported taking a multi- or single ingredient supplement containing

calcium on a given day (3). Compared to males, a higher percentage of females over 20 years and older

reported supplement intake (26% versus 37%) (3). The average intake of calcium from multi- or single

ingredient supplements was 521 mg (3). As Figure 5 illustrates, females taking supplements containing

calcium consume higher amounts of supplemental calcium compared to their male counterparts, and

males and females 60 years and older who take supplements containing calcium consume more

supplemental calcium than younger individuals

What is the contribution of supplements to calcium intake?

Figure 5. Contribution of diet and supplements to total calcium intake of those who report taking a supplement on

a given day, WWEIA, NHANES 2009-2010

-4-

875

964

1048

1043

1355

1313

1245

1079

1175

754

692

387

452

384

312

330

177

156

0 500 1000 1500 2000 2500

60+

40-59

20-39

60+

40-59

20-39

12-19

6-11

2-5

Diet

Supplements

1331

1256

1575

1435

1656

1629

1625

1739

1495

Males

Females

SOURCE: What We Eat in America, NHANES 2009-2010, day 1, individuals 2+ years

Reporters of calcium-containing supplements only (n=1,883)

Age (years)

Males and

Females

Calcium (mg)

FSRG Dietary Data Brief -- No.

13 -- September 2014

Table 1 shows the contribution of WWEIA food categories to calcium intake of the population. Milk and

dairy products contributed over one-third (37%) to total calcium intake, of which about half (19%) was

from plain milk. This included milk consumed as a beverage, added to cereal, or added to another

beverage. About one-third of the contribution from milk and dairy was from cheese. Mixed dishes

accounted for 17% of calcium intake, which included cheese in pizza, sandwiches (primarily from fast

food) and mixed ingredient items such as tacos, burritos, pasta dishes, and macaroni and cheese. Grains,

primarily grain products, provided 12% of calcium, over half of which was from breads, rolls and tortillas

(7%).

What foods contribute to calcium intake of the population?

Table 1. Contribution of What We Eat In America Food Categories to calcium intake of U.S. population, WWEIA, NHANES,

2009-2010.

-5-

†

Food categories not listed contribute 3% or less to calcium intake of the population, including Fruit, Fats and oils, Condiments and sauces,

Sugars, and Alcoholic beverages.

Percentage of individuals reporting the foods in the category at least once on the reporting day.

SOURCE: What We Eat in America, NHANES 2009-2010, day 1, individuals 2+ years

Food Category

Individuals

Reporting

(%)

Contribution

to calcium

intake (%)

Milk and dairy

73 37

Milk: whole, reduced, low and non-fat milk

Flavored milk: chocolate and other flavored milk

Cheese: cheese and cottage/ricotta cheese

Yogurt: plain and flavored yogurt

Mixed dishes 68 17

Grain-based: pasta dishes, macaroni and cheese, burritos, tacos, tamales, fried rice

Pizza: fast food/restaurant and frozen pizza

Grains 85 12

Breads, rolls, tortillas: yeast breads/rolls, flour and corn tortillas, bagels, English muffins

66 7

Non-alcoholic beverages, excluding plain and flavored milk 90 8

100% juice: citrus juice, other fruit and vegetable juices

25 4

Snacks and sweets: ice cream, frozen dairy products, candy containing chocolate,

cakes and pies, tortilla/corn chips

80 7

Protein foods

: meats, poultry, seafood, cured meats, plant-based protein foods 82 5

Vegetables:

potatoes, dark green vegetables, lettuce and salads, other vegetables 67 4

FSRG Dietary Data Brief -- No.

13-- September 2014

Definitions

Estimates in this report are based on one day of dietary intake data collected in What We Eat in America,

the dietary intake interview component of the National Health and Nutrition Examination Survey

(NHANES) in 2009-2010. Data on calcium consumption and contribution of foods to dietary calcium

intake are based on Day 1 dietary intake data of 9042 individuals age 2 years and older with complete and

reliable intakes, excluding breastfed infants. Sample weights were applied in all analyses to produce

nationally representative estimates.

Data source

1. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary

Guidelines for Americans, 2010. 7

Edition, Washington, DC: U.S. Government Printing Office,

December, 2010

2. Moshfegh, A. The State of the American Diet. http://www.health.gov/dietaryguidelines/2015-

binder/2015/docs/fedPresentations/stateOfTheAmericanDiet_Moshfegh.pdf, Accessed 07-12-13

3. U.S. Department of Agriculture, Agricultural Research Service. 2012. Total Nutrient Intakes: Percent

Reporting and Mean Amounts of Selected Vitamins and Minerals from Food and Dietary

Supplements, by Gender and Age, What We Eat in America, NHANES 2009-2010. Available:

www.ars.usda.gov/ba/bhnrc/fsrg

4. National Research Council. Dietary Reference Intakes for Calcium and Vitamin D. Washington,

DC: The National Academies Press, 2011

References

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Estimated Average Requirement (EAR) : the nutrient intake value that is estimated to meet the

requirement defined by a specified indicator of adequacy in 50 percent of the individuals in a life

stage and gender group (4).

calcium density: The amount of calcium in a specified amount of a food or diet in order to make

comparisons. Comparisons of the calcium density of foods are usually on a per 100 gram basis, and

comparisons of the calcium density of the diet are usually on a per 1000 kcal basis.

www.ars.usda.gov/ba/bhnrc/fsrg

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6382 (TDD). USDA is an equal opportunity provider and employer.

FSRG Dietary Data Brief -- No.

U.S. DEPARTMENT OF AGRICULTURE

Agricultural Research Service

Beltsville Human Nutrition Research Center

Food Surveys Research Group

www.ars.usda.gov/ba/bhnrc/fsrg

All material appearing in this report is in the public domain and may be reproduced or copied without

permission. However, citation as to source is appreciated.

13 -- September 2014

Hoy MK, Goldman JD. Calcium intake of the U.S. population: What We Eat in America, NHANES 2009-

2010. Food Surveys Research Group Dietary Data Brief No. 13. September 2014.

Suggested citation

M. Katherine Hoy and Joseph D. Goldman are with the Food Surveys Research Group, Beltsville Human

Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture.

About the authors