Dietary calcium intake - a critical reappraisal.

The clinical implications of calcium deficiency include rickets, poor bone mass accrual as well as abnormal foetal programming during pregnancy, poor peak bone mass due to poor accrual in childhood and adolescence, postmenopausal osteoporosis and osteoporosis of the elderly. Serum calcium is maintained within a narrow normal range, chiefly by resorption from the skeleton and alteration of urinary calcium loss and absorption from gut. Absorption is dependent on vitamin D sufficiency, presence of calcium binders in diet (such as phosphate, oxalate and phytate), age group and physiological state. A 2004 WHO expert panel has examined available data on calcium balance studies as well as calcium deficiency states and recommended daily calcium intake in the adult to be 1000 mg per day, with adjustments suggested for other age groups and physiological states. Daily calcium intake in India, both the reality and the recommendations, are far lower than the Western data. A reappraisal of dietary calcium recommendations may be necessary for India.