Associations Between Calcium Intake, Functional Ability, and Healthcare Costs: A Prospective Cohort Study

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Background:Calcium is an essential dietary element and the most abundant mineral in the human body; moreover, calcium is critical for health. Nonetheless, a significant proportion of Chinese adults fail to meet dietary calcium recommendations. Therefore, this study aimed to assess the associations between sufficient calcium intake, functional ability, and healthcare costs among older adults in China.Methods:Nationwide panel data from the China Health and Nutrition Survey (CHNS) were analyzed for 3127 adults aged ≥55 years from 219 communities across nine provinces. Dietary intake was measured using three consecutive 24-hour recalls, and calcium intake was calculated using the Chinese Food Composition Tables. Calcium sufficiency was defined as an intake of ≥800 mg/day, based on the 2023 Dietary Reference Intake for China. Functional ability was assessed using the Lawton–Brody Instrumental Activities of Daily Living (IADL) index. Fixed-effects linear regression models were used to evaluate associations with functional ability and healthcare costs.Results:Only 30.5% of participants met the recommended calcium intake, with a mean intake of 689 mg/day. Calcium sufficiency was associated with a 0.09-point higher overall IADL score (p < 0.01), with stronger associations among adults aged ≥65 years (0.29; p < 0.001), women (0.17; p < 0.001), non-married individuals (0.38; p < 0.001), those with an elementary school education or less (0.14; p = 0.02), and individuals with chronic conditions (0.28; p < 0.001). Calcium sufficiency was also associated with a 7.8% reduction in four-week healthcare expenditures (Chinese Yuan [CNY] 8.77 or US Dollar [USD] 1.25), corresponding to approximately CNY 114 (USD 16.3) in annual savings. Stronger associations with healthcare expenditures were observed among socioeconomically and health-vulnerable subgroups.Conclusions:Calcium intake insufficiency is widespread among older adults in China and is associated with lower functional ability and higher healthcare costs. Meanwhile, improving calcium intake is associated with meaningful gains in functional independence and lower healthcare expenditures, particularly among vulnerable populations.

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