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University of British Columbia, Vancouver, British Columbia, Canada V6T 1Z4
2To whom correspondence should be addressed. E-mail: sibarr{at}interchange.ubc.ca.
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ABSTRACT |
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 TOP ABSTRACT METHODSRESULTS AND DISCUSSIONLITERATURE CITED |
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KEY WORDS: • dairy products • dietary calcium • body weight • body composition • randomized controlled trials • dietary supplements
Recently, several observational studies detected inverse associations between calcium intake and body weight or body fat (1
–3
), and Zemel and colleagues established a possible mechanism using an obese mouse model and cultured human adipocytes (4
–6
). Briefly, it was demonstrated that low calcium diets lead to an increase in intracellular calcium concentrations, which in turn act to promote body fat deposition, reduce lipolysis and reduce thermogenesis. High calcium diets reverse these trends, and it appears that calcium in the form of dairy products may be more effective than elemental calcium (5
). Other components in dairy products may also play a role in body weight regulation: conjugated linoleic acid has been shown to reduce body fat accumulation in several animal models (7
), although the effects in humans appear to be less consistent (8
,9
). Clearly, much work remains to be completed before the relevance of these findings to normal nutrition in humans is understood. In the interim, however, some insight may be gained by reviewing results of published randomized studies in which dairy product intake or calcium intake was experimentally manipulated. Accordingly, this review was undertaken by searching the literature for studies of this nature, to assess whether the results support or refute the hypothesis that increased dairy product or calcium intakes are associated with a relative reduction in body weight or body fat.
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METHODS |
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TOPABSTRACTMETHODSRESULTS AND DISCUSSIONLITERATURE CITED |
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RESULTS AND DISCUSSION |
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TOPABSTRACTMETHODSRESULTS AND DISCUSSIONLITERATURE CITED |
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Eight studies were located in which participants were randomly assigned to increase dairy product intake or to maintain their "usual" diets (10
–18
), and one reported results of a randomized crossover trial (19
). Three of the studies were conducted in adolescent girls (10
–12
), one in premenopausal women (13
), one in women within 5 y of menopause (19
) and the remainder in postmenopausal women (one of which also included men) (14
–18
). Information about these studies and their findings regarding changes in anthropometric parameters is summarized in Table 1
. Briefly, most studies did not detect group differences in the changes in weight, height, fat mass or lean mass. However, two studies conducted in older adults observed significantly greater weight gains in the dairy-supplemented groups (17
,18
).
|
). It would be naïve to expect that subjects randomized to increase their intake of dairy products would simply add these to their customary diets, without compensating in some way for the additional energy content provided by the dairy foods. Of the studies reported in Table 1
that monitored energy intake, two suggest that compensation may have been complete, given that energy intakes did not differ between the dairy and usual diet groups (10
,12
). Merrilees and colleagues suggest that, in their subject group, this may have resulted from a reduced consumption of baked goods in the dairy product group (12
). Partial compensation is suggested in several of the remaining studies. Cadogan and colleagues (11
) detected a tendency for energy intake to increase in the milk group (P = 0.065); Barr and colleagues (18
) observed that energy intake increased in the milk group, but not as much as would be expected by simply adding milk to the usual diet; and Lau and colleagues (17
) found that energy intake decreased significantly in the control group. Although serious questions have arisen regarding the ability of diet records to reflect actual energy intake (21
), the two studies that detected significant differences in body weight change between the dairy-supplemented and control groups also detected corresponding significant differences in reported energy intake (17
,18
). In summary, the available data suggest that in most cases, body weight or composition do not change when dairy product intake is increased, although in some cases, significant increases occur. Whether these observations support the concept that calcium or dairy products increase energy utilization depends on the extent to which compensation occurred for the additional energy contained in the dairy products. Because of the difficulty of accurately documenting energy intake in free-living humans, it is unlikely that studies of this nature will address this issue in a definitive manner. Instead, randomized trials of calcium supplementation may provide data that can be more readily interpreted.
Increased calcium intake.
Twelve randomized trials of calcium supplementation that provided information on changes in body weight or composition were located (22
–33
), and for another five, information about group differences was obtained from study authors (16
,34
–37
). As shown in Table 2
, seven trials were conducted in children or adolescents (22
–28
), two in women during lactation (36
,37
), one in perimenopausal women (32
), five in postmenopausal women (one of these studies also included male subjects) (16
,30
,31
,34
,35
) and two were conducted during weight loss in pre- and postmenopausal women (29
,33
). The studies varied in length from 3 mo to 4 y, and included subjects that varied in ethnicity and baseline calcium intake.
|
–29
,31
–33
,36
,37
). Only one of 17 studies, that of Recker and colleagues (30
), detected a difference in body weight change. During the 4-y study, postmenopausal women receiving 1.2 g calcium/d lost 0.35 kg/y more than did the control group (3
). The only significantly different change in body composition was observed in the study of Riggs and colleagues (34
). In their 4-y study, women supplemented with 1.6 g calcium/d had a more negative change in lean mass than that of controls, although group differences in weight and fat mass were not observed (Riggs, B. L., unpublished results, personal communication, March 2002).
The reason for the discrepancy between the study of Recker and colleagues (30
) and the remaining studies, in which an increased calcium intake was not associated with increased weight loss (or less weight gain), is not readily apparent. It does not appear to be attributed to variables such as sample size, baseline calcium intake, the amount or type of calcium administered, the age, relative weight or ethnicity of the subjects or study duration. Recker’s study was somewhat unusual in that it was the only study of nonintentional weight loss in which the control group lost a significant amount of weight (3
), but how this could contribute to the different results is not evident.
Similarly, there is no ready explanation for the lower lean mass among the calcium-treated women studied by Riggs and colleagues (34
). Animal studies have suggested that a high calcium intake is associated with decreases in fat mass rather than lean tissue (5
,6
).
This review of randomized trials of increased dairy product or calcium intake obtained little evidence to support the hypothesis that calcium or other components of dairy products have a measurable impact on body weight in generally healthy humans. Although seven of nine randomized studies of increased dairy product intake did not detect an increased weight gain in the dairy product group, interpretation of this finding is limited by the inability to accurately determine the extent of compensation for the energy intake from the added dairy products. Only one of 17 randomized trials of calcium supplementation found a significantly greater weight loss (or smaller weight gain) in the calcium-supplemented group, and it could be argued that this is close to what would be expected on the basis of chance alone.
The above conclusion must be tempered by the inherent limitations of this review. First, the approach used to conduct the review did not capture all available data on the topic. Some papers would have been missed in the initial search; some would have been excluded by limiting results to the English language; correct e-mail addresses for some authors could not be located; and some authors did not respond to e-mail messages that were sent. Given the relative consistency of the results that were obtained, it seems unlikely that this would have materially altered the findings; however, this possibility cannot be excluded. Second, it must be recognized that most studies reviewed were neither designed nor powered to detect an impact of increased dairy product or calcium intake on body weight, and the absence of significant findings in no way precludes the possibility that such findings may be obtained in carefully designed studies. Questions that remain to be addressed include the following: 1) Is there a meaningful effect of calcium and/or other dairy components on body energy utilization and weight regulation in humans?; 2) If the effect exists, is it observed consistently or is there a susceptible subset for whom it is effective?; 3) How much calcium/dairy product intake is required?; and 4) What is the likely impact at the population level?
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FOOTNOTES |
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LITERATURE CITED |
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TOPABSTRACTMETHODSRESULTS AND DISCUSSIONLITERATURE CITED |
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1. Carruth, B. R. & Skinner, J. D. (2001) The role of dietary calcium and other nutrients in moderating body fat in preschool children. Int. J. Obes. 25:559-566.
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3. Davies, K. M., Heaney, R. P., Recker, R. R., Lappe, J. M., Barger-Lux, J., Rafferty, K. & Hinders, S. (2000) Calcium intake and body weight. J. Clin. Endocrinol. Metab. 85:4635-4638.
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5. Shi, H., DiRienzo, D. & Zemel, M. B. (2002) Effects of dietary calcium on adipocyte lipid metabolism and body weight regulation in energy-restricted aP2-agouti transgenic mice. FASEB J. 15:291-293.
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22. Dibba, B., Prentice, A., Ceesay, M., Stirling, D. M., Cole, T. J. & Poskitt, E.M.E. (2000) Effect of calcium supplementation on bone mineral accretion in Gambian children accustomed to a low-calcium diet. Am. J. Clin. Nutr. 71:544-549.
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26. Lloyd, T., Andon, M. B., Rollings, N., Martel, J. K., Landis, J. R., Demers, L. M., Eggli, D. F., Kieselhorst, K. & Kulin, H. E. (1993) Calcium supplementation and bone mineral density in adolescent girls. J. Am. Med. Assoc. 270:841-844.
27. Bonjour, J.-P., Carrie, A.-L., Ferrari, S., Clavien, H., Slosman, D., Theintz, G. & Rizzoli, R. (1997) Calcium-enriched foods and bone mass in prepubertal girls: a randomized, double-blind, placebo-controlled trial. J. Clin. Invest. 99:1287-1294.[Medline]
28. Nowson, C. A., Green, R. M., Hopper, J. L., Sherwin, A. J., Young, D., Kaymakci, B., Guest, C. S., Smid, M., Larkings, R. G. & Wark, J. D. (1997) A co-twin study of the effect of calcium supplementation on bone density during adolescence. Osteoporos. Int. 7:219-225.[Medline]
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