Diabetes Metab J.  2017 Feb;41(1):60-68. 10.4093/dmj.2017.41.1.60.

Serum Calcium and the Risk of Incident Metabolic Syndrome: A 4.3-Year Retrospective Longitudinal Study

• Baek JH
• Jin SM
• Bae JC
• Jee JH
• Yu TY
• Kim SK
• Hur KY
• Lee MK
• Kim JH

• KMID: 2368530
• DOI: http://doi.org/10.4093/dmj.2017.41.1.60

Abstract

BACKGROUND
An association between serum calcium level and risk of metabolic syndrome (MetS) has been suggested in cross-sectional studies. This study aimed to evaluate the association between baseline serum calcium level and risk of incident MetS in a longitudinal study.
METHODS
We conducted a retrospective longitudinal study of 12,706 participants without MetS who participated in a health screening program, had normal range serum calcium level at baseline (mean age, 51 years), and were followed up for 4.3 years (18,925 person-years). The risk of developing MetS was analyzed according to the baseline serum calcium levels.
RESULTS
A total of 3,448 incident cases (27.1%) of MetS developed during the follow-up period. The hazard ratio (HR) for incident MetS did not increase with increasing tertile of serum calcium level in an age- and sex-matched model (P for trend=0.915). The HRs (95% confidence interval [CI]) for incident MetS comparing the second and the third tertiles to the first tertile of baseline serum calcium level were 0.91 (95% CI, 0.84 to 0.99) and 0.85 (95% CI, 0.78 to 0.92) in a fully adjusted model, respectively (P for trend=0.001). A decreased risk of incident MetS in higher tertiles of serum calcium level was observed in subjects with central obesity and/or a metabolically unhealthy state at baseline.
CONCLUSION
There was no positive correlation between baseline serum calcium levels and incident risk of MetS in this longitudinal study. There was an association between higher serum calcium levels and decreased incident MetS in individuals with central obesity or two components of MetS at baseline.

Keyword

Calcium; Longitudinal studies; Metabolic syndrome; Obesity, abdominal

MeSH Terms

Calcium*
Cross-Sectional Studies
Follow-Up Studies
Longitudinal Studies*
Mass Screening
Obesity, Abdominal
Reference Values
Retrospective Studies*
Calcium

Figure

• 

  Fig. 1 Subject inclusion. MetS, metabolic syndrome.

Reference

1. Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: a summary of the evidence. Diabetes Care. 2005; 28:1769–1778.

2. Vernay M, Salanave B, de Peretti C, Druet C, Malon A, Deschamps V, Hercberg S, Castetbon K. Metabolic syndrome and socioeconomic status in France: The French Nutrition and Health Survey (ENNS, 2006-2007). Int J Public Health. 2013; 58:855–864.

3. Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol. 2008; 28:629–636.

4. Beltran-Sanchez H, Harhay MO, Harhay MM, McElligott S. Prevalence and trends of metabolic syndrome in the adult U.S. population, 1999-2010. J Am Coll Cardiol. 2013; 62:697–703.

5. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Yoon JW, Choi SH, Cho SI, Park KS, Lee HK, Jang HC, Koh KK. Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998-2007. Diabetes Care. 2011; 34:1323–1328.

6. Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med. 2011; 9:48.

7. Despres JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006; 444:881–887.

8. Meigs JB, Wilson PW, Fox CS, Vasan RS, Nathan DM, Sullivan LM, D'Agostino RB. Body mass index, metabolic syndrome, and risk of type 2 diabetes or cardiovascular disease. J Clin Endocrinol Metab. 2006; 91:2906–2912.

9. Zemel MB, Shi H, Greer B, Dirienzo D, Zemel PC. Regulation of adiposity by dietary calcium. FASEB J. 2000; 14:1132–1138.

10. Ojuka EO, Jones TE, Nolte LA, Chen M, Wamhoff BR, Sturek M, Holloszy JO. Regulation of GLUT4 biogenesis in muscle: evidence for involvement of AMPK and Ca(2+). Am J Physiol Endocrinol Metab. 2002; 282:E1008–E1013.

11. Lorenzo C, Hanley AJ, Rewers MJ, Haffner SM. Calcium and phosphate concentrations and future development of type 2 diabetes: the Insulin Resistance Atherosclerosis Study. Diabetologia. 2014; 57:1366–1374.

12. Ren XH, Yao YS, He LP, Jin YL, Chang WW, Li J, Chen Y, Song XL, Tang H, Ding LL, Guo DX, Li CP. Overweight and obesity associated with increased total serum calcium level: comparison of cross-sectional data in the health screening for teaching faculty. Biol Trace Elem Res. 2013; 156:74–78.

13. Lind L, Jakobsson S, Lithell H, Wengle B, Ljunghall S. Relation of serum calcium concentration to metabolic risk factors for cardiovascular disease. BMJ. 1988; 297:960–963.

14. Saltevo J, Niskanen L, Kautiainen H, Teittinen J, Oksa H, Korpi-Hyovalti E, Sundvall J, Mannisto S, Peltonen M, Mantyselka P, Vanhala M. Serum calcium level is associated with metabolic syndrome in the general population: FIN-D2D study. Eur J Endocrinol. 2011; 165:429–434.

15. Guessous I, Bonny O, Paccaud F, Mooser V, Waeber G, Vollenweider P, Bochud M. Serum calcium levels are associated with novel cardiometabolic risk factors in the population-based CoLaus study. PLoS One. 2011; 6:e18865.

16. Jorde R, Sundsfjord J, Bonaa KH. Determinants of serum calcium in men and women. The Tromso Study. Eur J Epidemiol. 2001; 17:1117–1123.

17. Becerra-Tomas N, Estruch R, Bullo M, Casas R, Diaz-Lopez A, Basora J, Fito M, Serra-Majem L, Salas-Salvado J. Increased serum calcium levels and risk of type 2 diabetes in individuals at high cardiovascular risk. Diabetes Care. 2014; 37:3084–3091.

18. Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart JC, James WP, Loria CM, Smith SC Jr. International Diabetes Federation Task Force on Epidemiology and Prevention. Hational Heart, Lung, and Blood Institute. American Heart Association. World Heart Federation. International Atherosclerosis Society. International Association for the Study of Obesity. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009; 120:1640–1645.

19. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001; 285:2486–2497.

20. Hypertension Detection and Follow-up Program Cooperative Group 1979. Five-year findings of the hypertension detection and follow-up program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension. JAMA. 1997; 277:157–166.

21. Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (HOMA) evaluation uses the computer program. Diabetes Care. 1998; 21:2191–2192.

22. Kim MK, Kim G, Jang EH, Kwon HS, Baek KH, Oh KW, Lee JH, Yoon KH, Lee WC, Lee KW, Son HY, Kang MI. Altered calcium homeostasis is correlated with the presence of metabolic syndrome and diabetes in middle-aged and elderly Korean subjects: the Chungju Metabolic Disease Cohort study (CMC study). Atherosclerosis. 2010; 212:674–681.

23. Park SH, Kim SK, Bae YJ. Relationship between serum calcium and magnesium concentrations and metabolic syndrome diagnostic components in middle-aged Korean men. Biol Trace Elem Res. 2012; 146:35–41.

24. Cho GJ, Shin JH, Yi KW, Park HT, Kim T, Hur JY, Kim SH. Serum calcium level is associated with metabolic syndrome in elderly women. Maturitas. 2011; 68:382–386.

25. Hagstrom E, Hellman P, Lundgren E, Lind L, Arnlov J. Serum calcium is independently associated with insulin sensitivity measured with euglycaemic-hyperinsulinaemic clamp in a community-based cohort. Diabetologia. 2007; 50:317–324.

26. Sun G, Vasdev S, Martin GR, Gadag V, Zhang H. Altered calcium homeostasis is correlated with abnormalities of fasting serum glucose, insulin resistance, and beta-cell function in the Newfoundland population. Diabetes. 2005; 54:3336–3339.

27. Aoki K, Miyagawa K. Correlation of increased serum calcium with elevated blood pressure and vascular resistance during calcium infusion in normotensive man. J Hypertens. 1990; 8:579–583.

28. Ahlstrom T, Hagstrom E, Larsson A, Rudberg C, Lind L, Hellman P. Correlation between plasma calcium, parathyroid hormone (PTH) and the metabolic syndrome (MetS) in a community-based cohort of men and women. Clin Endocrinol (Oxf). 2009; 71:673–678.

29. Hjelmesaeth J, Hofso D, Aasheim ET, Jenssen T, Moan J, Hager H, Roislien J, Bollerslev J. Parathyroid hormone, but not vitamin D, is associated with the metabolic syndrome in morbidly obese women and men: a cross-sectional study. Cardiovasc Diabetol. 2009; 8:7.