Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Variation in intakes of calcium, phosphorus, magnesium, iron and potassium in 10 countries in the European Prospective Investigation into Cancer and Nutrition study

European Journal of Clinical Nutrition volume 63, pages S101–S121 (2009)Cite this article

Abstract

Background/objectives:

Adequate mineral intake is important for the maintenance of bone health, cellular function and general metabolism, and possibly in the aetiology of cancer and other chronic diseases. This study aimed at investigating variation in intakes of selected minerals across 10 European countries participating in the EPIC (European Prospective Investigation into Cancer and Nutrition) study.

Methods:

Nutrient intakes for 36 034 subjects, aged between 35 and 74 years, in 27 centres were obtained using standardized 24-h dietary recall software (EPIC-SOFT). Mean intakes of calcium, phosphorus, magnesium, iron and potassium were calculated by centre and weighted by season and day of the week and were also stratified by age group. The contribution of food groups to total nutrient intake was calculated.

Results:

There was clear geographical variability in intakes, with differences ranging from 35% for magnesium to 90% for iron in men and 36% for potassium to 75% for calcium in women, and a twofold difference in sources of haem iron (meat and fish). There was a geographical gradient in iron intake, with higher intakes in Southern than in Northern Europe and also around a twofold north–south gradient in the contribution of fruits and vegetables to potassium intake. Compared with reference intakes, the majority of age groups and centres had intakes above the recommended levels. Dairy foods and products contributed the most to calcium and phosphorus intake in almost all centres. Cereals and cereal products contributed the most to magnesium and iron intakes, except in Greece and Germany.

Conclusions:

Intakes of minerals vary substantially throughout Europe, with some geographical variability in their food sources.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  • Al-Delaimy WK, Ferrari P, Slimani N, Pala V, Johansson I, Nilsson S et al. (2005). Plasma carotenoids as biomarkers of intake of fruits and vegetables: individual-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Clin Nutr 59, 1387–1408.

    Article  CAS  Google Scholar 

  • Barbagallo M, Dominguez LJ, Resnick LM (2007). Magnesium metabolism in hypertension and type 2 diabetes mellitus. Am J Ther 14, 375–385.

    Article  Google Scholar 

  • Baron JA, Beach M, Wallace K, Grau MV, Sandler RS, Mandel JS et al. (2005). Risk of prostate cancer in a randomized clinical trial of calcium supplementation. Cancer Epidemiol Biomarkers Prev 14, 586–589.

    Article  CAS  Google Scholar 

  • Brustad M, Skeie G, Braaten T, Slimani N, Lund E (2003). Comparison of telephone vs face-to-face interviews in the assessment of dietary intake by the 24 h recall EPIC SOFT program—the Norwegian calibration study. Eur J Clin Nutr 57, 107–113.

    Article  CAS  Google Scholar 

  • COMA (Committee on Medical Aspects of Food Policy) (1991). Dietary Reference Values for Food Energy and Nutrients for the United Kingdom. Department of Health Report on Health and Social Subjects No. 41. HMSO: London.

  • Dai Q, Shrubsole MJ, Ness RM, Schlundt D, Cai Q, Smalley WE et al. (2007). The relation of magnesium and calcium intakes and a genetic polymorphism in the magnesium transporter to colorectal neoplasia risk. Am J Clin Nutr 86, 743–751.

    Article  CAS  Google Scholar 

  • EC (European Commission DVF) (1998). Report on Osteoporosis in the European Community: Action for Prevention. Office for Official Publications of the European Communities, Bernan Associates (distributor): Luxembourg.

  • Elmadfa I, Weichselbaum E (eds) (2005). European Nutrition and Health Report 2004. Forum Nutrition, vol. 58. Karger: Basel.

    Book  Google Scholar 

  • FAO Agriculture Unit, Goskomstat (2007). Food Balance Sheets: History, Sources, Concepts and Definitions. Report of a Workshop on Supply Utilization Accounts and Food Balance Sheets, Dushanbe, Tajikistan, 7–9 May 2007.

  • Ferrari P, Kaaks R, Fahey MT, Slimani N, Day NE, Pera G et al. (2004). Within- and between-cohort variation in measured macronutrient intakes, taking account of measurement errors, in the European Prospective Investigation into Cancer and Nutrition study. Am J Epidemiol 160, 814–822.

    Article  Google Scholar 

  • Ferrari P, Roddam A, Fahey MT, Jenab M, Bamia C, Ocké M et al. (2009). A bivariate measurement error model for nitrogen and potassium intakes to evaluate the performance of regression calibration in the EPIC study. Eur J Clin Nutr 63 (Suppl 4), S179–S187.

    Article  CAS  Google Scholar 

  • Folsom AR, Hong CP (2006). Magnesium intake and reduced risk of colon cancer in a prospective study of women. Am J Epidemiol 163, 232–235.

    Article  Google Scholar 

  • Friedenreich C, Cust A, Lahmann PH, Steindorf K, Boutron-Ruault MC, Clavel-Chapelon F et al. (2007). Physical activity and risk of endometrial cancer: the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 121, 347–355.

    Article  CAS  Google Scholar 

  • Haftenberger M, Lahmann PH, Panico S, Gonzalez CA, Seidell JC, Boeing H et al. (2002a). Overweight, obesity and fat distribution in 50- to 64-year-old participants in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5 (Suppl), S1147–S1162.

    Article  Google Scholar 

  • Haftenberger M, Schuit AJ, Tormo MJ, Boeing H, Wareham N, Bueno-de-Mesquita HB et al. (2002b). Physical activity of subjects aged 50–64 years involved in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 5 (Suppl), S1163–S1176.

    Article  Google Scholar 

  • He FJ, MacGregor GA (2008). Beneficial effects of potassium on human health. Physiol Plant 133, 725–735.

    Article  CAS  Google Scholar 

  • Lamprecht SA, Lipkin M (2001). Cellular mechanisms of calcium and vitamin D in the inhibition of colorectal carcinogenesis. Ann N Y Acad Sci 952, 73–87.

    Article  CAS  Google Scholar 

  • Larsson SC, Bergkvist L, Rutegard J, Giovannucci E, Wolk A (2006). Calcium and dairy food intakes are inversely associated with colorectal cancer risk in the cohort of Swedish men. Am J Clin Nutr 83, 667–673; quiz 728–669.

    Article  CAS  Google Scholar 

  • Larsson SC, Wolk A (2007). Magnesium intake and risk of type 2 diabetes: a meta-analysis. J Intern Med 262, 208–214.

    Article  CAS  Google Scholar 

  • Lin J, Cook NR, Lee IM, Manson JE, Buring JE, Zhang SM (2006). Total magnesium intake and colorectal cancer incidence in women. Cancer Epidemiol Biomarkers Prev 15, 2006–2009.

    Article  CAS  Google Scholar 

  • Linseisen J, Kesse E, Slimani N, Bueno-de-Mesquita HB, Ocke MC, Skeie G et al. (2002). Meat consumption in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts: results from 24-hour dietary recalls. Public Health Nutr 5 (Suppl), S1243–S1258.

    Article  Google Scholar 

  • MAAF (Ministry of Agriculture and Fisheries) (1998). The Bread and Flour Regulations 1998. HMSO: London.

  • Mammas I, Bertsias G, Linardakis M, Moschandreas J, Kafatos A (2004). Nutrient intake and food consumption among medical students in Greece assessed during a clinical nutrition course. Int J Food Sci Nutr 55, 17–26.

    Article  Google Scholar 

  • Mizushima S, Cappuccio FP, Nichols R, Elliott P (1998). Dietary magnesium intake and blood pressure: a qualitative overview of the observational studies. J Hum Hypertens 12, 447–453.

    Article  CAS  Google Scholar 

  • Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al. (2002). European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5 (Suppl), S1113–S1124.

    Article  Google Scholar 

  • Riboli E, Kaaks R (1997). The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26 (Suppl 1), S6–S14.

    Article  Google Scholar 

  • Rodriguez C, McCullough ML, Mondul AM, Jacobs EJ, Fakhrabadi-Shokoohi D, Giovannucci EL et al. (2003). Calcium, dairy products, and risk of prostate cancer in a prospective cohort of United States men. Cancer Epidemiol Biomarkers Prev 12, 597–603.

    CAS  PubMed  Google Scholar 

  • Saadatian-Elahi M, Slimani N, Chajès V, Jenab M, Goudable J, Biessy C et al. (2009). Plasma phospholipid fatty acid profiles and their association with food intakes: Results from a cross-sectional study within the European Prospective Investigation into Cancer and Nutrition (EPIC). Am J Clin Nutr 89, 331–346.

    Article  CAS  Google Scholar 

  • Skeie G, Braaten T, Hjartåker A, Lentjes M, Amiano P, Jakszyn P et al. (2009). Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study. Eur J Clin Nutr 63 (Suppl 4), S226–S238.

    Article  CAS  Google Scholar 

  • Slimani N, Bingham S, Runswick S, Ferrari P, Day NE, Welch AA et al. (2003). Group level validation of protein intakes estimated by 24-hour diet recall and dietary questionnaires against 24-hour urinary nitrogen in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. Cancer Epidemiol Biomarkers Prev 12, 784–795.

    PubMed  Google Scholar 

  • Slimani N, Deharveng G, Unwin I, Southgate DA, Vignat J, Skeie G et al. (2007). The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr 61, 1037–1056.

    Article  CAS  Google Scholar 

  • Slimani N, Ferrari P, Ocke M, Welch A, Boeing H, Liere M et al. (2000). Standardization of the 24-hour diet recall calibration method used in the European Prospective Investigation into Cancer and Nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54, 900–917.

    Article  CAS  Google Scholar 

  • Slimani N, Kaaks R, Ferrari P, Casagrande C, Clavel-Chapelon F, Lotze G et al. (2002). European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr 5 (Suppl), S1125–S1145.

    Article  Google Scholar 

  • Song Y, Li TY, van Dam RM, Manson JE, Hu FB (2007). Magnesium intake and plasma concentrations of markers of systemic inflammation and endothelial dysfunction in women. Am J Clin Nutr 85, 1068–1074.

    Article  CAS  Google Scholar 

  • Song Y, Manson JE, Cook NR, Albert CM, Buring JE, Liu S (2005a). Dietary magnesium intake and risk of cardiovascular disease among women. Am J Cardiol 96, 1135–1141.

    Article  CAS  Google Scholar 

  • Song Y, Ridker PM, Manson JE, Cook NR, Buring JE, Liu S (2005b). Magnesium intake, C-reactive protein, and the prevalence of metabolic syndrome in middle-aged and older U.S. women. Diabetes Care 28, 1438–1444.

    Article  CAS  Google Scholar 

  • van den Brandt PA, Smits KM, Goldbohm RA, Weijenberg MP (2007). Magnesium intake and colorectal cancer risk in the Netherlands Cohort Study. Br J Cancer 96, 510–513.

    Article  CAS  Google Scholar 

  • Voedingscentrum (1999). The Dutch National Food Consumption Survey 1997/1998 (Zo eet Nederland: Resultaten van de Voedselconsumptiepeiling 1997–1998). Voedingscentrum: The Hague.

  • WCRF/AICR (2007). Summary: Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective. World Cancer Research Fund/American Institute for Cancer Research: Washington, DC.

  • Welch A, Mulligan A, Luben R, Bingham SA (1998). Intake of selected nutrients from vitamin and mineral supplements by subjects in the EPIC Study, Norfolk, UK. Proc Nutr Soc 57, 154A.

    Google Scholar 

  • Welch AA, Lund E, Amiano P, Dorronsoro M, Brustad M, Kumle M et al. (2002). Variability of fish consumption within the 10 European countries participating in the European Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr 5 (Suppl), S1273–S1285.

    Article  Google Scholar 

  • WHO (2003). Prevention and Management of Osteoporosis. WHO Technical Report Series No. 921. World Health Organization: Geneva.

  • Wolf FI, Maier JA, Nasulewicz A, Feillet-Coudray C, Simonacci M, Mazur A et al. (2007). Magnesium and neoplasia: from carcinogenesis to tumor growth and progression or treatment. Arch Biochem Biophys 458, 24–32.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The work described in this paper was carried out with the financial support of the European Commission: Public Health and Consumer Protection Directorate 1993–2004; Research Directorate-General 2005; Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l’Education Nationale; Institut National de la Santé et de la Recherche Médicale (INSERM); Institut Gustave Roussy; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra and the Catalan Institute of Oncology; and ISCIII RETIC (RD06/0020), Spain; Cancer Research UK; Medical Research Council, UK; the Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; the Wellcome Trust, UK; Greek Ministry of Health; Hellenic Health Foundation; Italian Association for Research on Cancer; Italian National Research Council, Regione Sicilia (Sicilian government); Associazione Iblea per la Ricerca Epidemiologica—ONLUS (Hyblean association for epidemiological research, NPO); Dutch Ministry of Health, Welfare and Sport; Dutch Prevention Funds; LK Research Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); Swedish Cancer Society; Swedish Research Council; Regional Government of Skane and the County Council of Vasterbotten, Sweden; Norwegian Cancer Society; the Norwegian Research Council and the Norwegian Foundation for Health and Rehabilitation. We thank Sarah Somerville, Nicole Suty and Karima Abdedayem for assistance with editing and Kimberley Bouckaert and Heinz Freisling for technical assistance.

Author information

Author notes

  1. A A Welch

    Present address: 24Current address: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.,

  2. P Ferrari

    Present address: 25Current address: Data Collection and Exposure Unit (DATEX), European Food Safety Authority, Parma, Italy.,

  3. J Linseisen

    Present address: 26Current address: Institute of Epidemiology, Helmholtz Centre Munich, Neuherberg, Germany.,

  4. S Bingham: The author is deceased.

Authors and Affiliations

  1. Department of Public Health and Primary Care, MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, University of Cambridge, Cambridge, UK

    A A Welch, M Lentjes & S Bingham

  2. National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

    H Fransen & M C Ocké

  3. Lifestyle and Cancer Group, International Agency for Research on Cancer, Lyon, France

    M Jenab

  4. Inserm, ERI 20, Institut Gustave Roussy, Villejuif, France

    M C Boutron-Ruault, M Touvier & M Niravong

  5. Cancer Registry, Azienda Ospedaliera ‘Civile—M.P. Arezzo’, Ragusa, Italy

    R Tumino

  6. Department of Preventive & Predictive Medicine, Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

    C Agnoli

  7. Department of Clinical Sciences, Lund University, Malmö, Sweden

    U Ericson

  8. Department of Odontology, Faculty of Medicine, University of Umeå, Umeå, Sweden

    I Johansson

  9. Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France

    P Ferrari & N Slimani

  10. Institute of Community Medicine, University of Tromsø, Tromsø, Norway

    D Engeset & E Lund

  11. Cancer Epidemiology Unit, University of Oxford, Oxford, UK

    T Key

  12. AFSSA (French Food Safety Agency), DERNS/PASER, Maisons-Alfort, France

    M Touvier

  13. Public Health Department of Guipuzkoa, Basque Government, San Sebastian and CIBER Epidemiología y Salud Pública (CIBERESP), Spain

    N Larrañaga

  14. Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain

    L Rodríguez

  15. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

    P H M Peeters

  16. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

    A Tjønneland

  17. Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

    L Bjerregaard

  18. Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece

    E Vasilopoulou & V Dilis

  19. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    J Linseisen

  20. Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany

    U Nöthlings

  21. Epidemiology Section, Institute for Experimental Medicine, University of Kiel, Kiel, Germany

    U Nöthlings

  22. Department of Epidemiology, Public Health and Primary Care, Imperial College, London, UK

    E Riboli

  23. Diet and Cancer Group, MRC Mitochondrial Biology Unit, Cambridge, UK

    S Bingham

Authors
  1. A A Welch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H Fransen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Jenab
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M C Boutron-Ruault
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R Tumino
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C Agnoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U Ericson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. I Johansson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. D Engeset
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. E Lund
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M Lentjes
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. T Key
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. M Touvier
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. M Niravong
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. N Larrañaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. L Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. M C Ocké
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. P H M Peeters
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. A Tjønneland
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. L Bjerregaard
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. E Vasilopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. V Dilis
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. J Linseisen
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. U Nöthlings
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. E Riboli
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. N Slimani
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. S Bingham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A A Welch.

Additional information

Guarantor: AA Welch. Contributors: AAW carried out the statistical analyses and wrote the paper. NS was overall coordinator of this project and the EPIC nutritional databases (ENDB) project. HF, MCB, MT, UN and MO contributed to the interpretation of results and drafting of the paper. The other co-authors were EPIC collaborators involved in the design of the study and the data collection. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the paper and approved the final version.

Appendix

Appendix

Tables A1,A2,A3,A4,A5

Table A1 Fully adjusteda mean daily intake of calcium by centre ordered from south to north, gender and age group
Full size table
Table A2 Fully adjusteda mean daily intake of phosphorus by centre ordered from south to north, gender and age group
Full size table
Table A3 Fully adjusteda mean daily intake of magnesium by centre ordered from south to north, gender and age group
Full size table
Table A4 Fully adjusteda mean daily intake of iron by centre ordered from south to north, gender and age group
Full size table
Table A5 Fully adjusteda mean daily intake of potassium by centre ordered from south to north, gender and age group
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Welch, A., Fransen, H., Jenab, M. et al. Variation in intakes of calcium, phosphorus, magnesium, iron and potassium in 10 countries in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 63 (Suppl 4), S101–S121 (2009). https://doi.org/10.1038/ejcn.2009.77

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2009.77

Keywords

This article is cited by

Search

Advanced search

Quick links