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[1]Peacock M. Calcium metabolism in health and disease. Clinical Journal of the American Society of Nephrology : CJASN. 2010; 5 Suppl 1: S23–S30. https://doi.org/10.2215/CJN.05910809
[2]Shlisky J, Mandlik R, Askari S, Abrams S, Belizan JM, Bourassa MW, et al. Calcium deficiency worldwide: prevalence of inadequate intakes and associated health outcomes. Annals of the New York Academy of Sciences. 2022; 1512: 10–28. https://doi.org/10.1111/nyas.14758
[3]Massé O, Mercurio CM, Dupuis S, Al Sahwi M, Arruda A, Dallaire G, et al. Calcium, vitamin D, or combined supplementation to prevent fractures and falls: systematic review and meta-analysis. BMJ. 2026; 393: e088050. https://doi.org/10.1136/bmj-2025-088050
[4]Dominguez LJ, Gonnelli S. Calcium, Vitamin D, and Aging in Humans. Nutrients. 2024; 16: 3974. https://doi.org/10.3390/nu16233974
[5]Zhang Q. New Insights into Nutrients for Bone Health and Disease. Nutrients. 2023; 15: 2648. https://doi.org/10.3390/nu15122648
[6]Cheng L, Lian J, Ding Y, Wang X, Munir MAM, Ullah S, et al. Calcium deficiency and its implications for cardiovascular disease and cancer: Strategies for resolution via agronomic fortification. Food Science & Nutrition. 2024; 12: 8594–8607. https://doi.org/10.1002/fsn3.4464
[7]Beltz S, Gloystein S, Litschko T, Laag S, van den Berg N. Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly. BMC Geriatrics. 2022; 22: 894. https://doi.org/10.1186/s12877-022-03621-3
[8]Amlak BT, Getinet M, Getie A, Kebede WM, Tarekegn TT, Belay DG. Functional disability in basic and instrumental activities of daily living among older adults globally: a systematic review and meta-analysis. BMC Geriatrics. 2025; 25: 413. https://doi.org/10.1186/s12877-025-06056-8
[9]Goodarzi F, Khoshravesh S, Ayubi E, Bashirian S, Barati M. Psychosocial determinants of functional independence among older adults: A systematic review and meta-analysis. Health Promotion Perspectives. 2024; 14: 32–43. https://doi.org/10.34172/hpp.42354
[10]Li J, Szanton SL, Li J. Latent cognitive profiles and their associations with instrumental activities of daily living among older adults without dementia: A United States national cross-sectional study. The Journal of Prevention of Alzheimer's Disease. 2025; 12: 100162. https://doi.org/10.1016/j.tjpad.2025.100162
[11]Pan C, Cao N, Kelifa MO, Luo S. Age and cohort trends in disability among Chinese older adults. Frontiers in Public Health. 2023; 11: 998948. https://doi.org/10.3389/fpubh.2023.998948
[12]Kogure M, Tsuchiya N, Narita A, Hirata T, Nakaya N, Nakamura T, et al. Relationship Between Calcium Intake and Impaired Activities of Daily Living in a Japanese Population: NIPPON DATA90. Journal of Epidemiology. 2021; 31: 119–124. https://doi.org/10.2188/jea.JE20190234
[13]Kim J, Lee Y. Frequency of dairy consumption and functional disability in older persons. The Journal of Nutrition, Health & Aging. 2011; 15: 795–800. https://doi.org/10.1007/s12603-011-0056-y
[14]Liu Z, Zhao L, Man Q, Wang J, Zhao W, Zhang J, et al. Dietary micronutrients intake status among Chinese elderly people living at home: Data from CNNHS 2010-2012. Nutrients. 2019; 11: 1787. https://doi.org/10.3390/nu11081787
[15]Liu Y, Huang X, Tang K, Wu J, Zhou J, Bai H, et al. Prevalence of osteoporosis and associated factors among Chinese adults: a systematic review and modelling study. Journal of Global Health. 2025; 15: 04009. https://doi.org/10.7189/jogh.15.04009
[16]Zhang Y, Zang W, Tian M, Zhang Y. The impact of preventive behaviors on self-rated health, depression symptoms, and daily functioning among middle-aged and elderly Chinese: An empirical study. Plos One. 2024; 19: e0305672. https://doi.org/10.1371/journal.pone.0305672
[17]United Nations Department of Economic and Social Affairs, Population Division. World Population Prospects 2022: Summary of Results. UN DESA/POP/2022/TR/NO.3. 2022. Available at: https://population.un.org/wpp/ (Accessed: 23 November 2025).
[18]Huang F, Wang Z, Zhang J, Du W, Su C, Jiang H, et al. Dietary calcium intake and food sources among Chinese adults in CNTCS. PloS One. 2018; 13: e0205045. https://doi.org/10.1371/journal.pone.0205045
[19]Chen X, Giles J, Yao Y, Yip W, Meng Q, Berkman L, et al. The path to healthy ageing in China: A Peking University-Lancet Commission. . 2022; 400: 1967–2006. https://doi.org/10.1016/S0140-6736(22)01546-X
[20]Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969; 9: 179–186.
[21]Arnold M, Rajagukguk YV, Gramza-Michałowska A. Functional Food for Elderly High in Antioxidant and Chicken Eggshell Calcium to Reduce the Risk of Osteoporosis-A Narrative Review. Foods (Basel, Switzerland). 2021; 10: 656. https://doi.org/10.3390/foods10030656
[22]Luo S, Zhang J, Heffernan M. Forecast of total health expenditure on China's ageing population: a system dynamics model. BMC Health Services Research. 2024; 24: 1655. https://doi.org/10.1186/s12913-024-12113-6
[23]Chen S, Li L, Yang J, Jiao L, Golden T, Wang Z, et al. The impact of long-term care insurance in China on beneficiaries and caregivers: A systematic review. . Journal of Global Health Economics and Policy. 2021; 1: e2021014. https://doi.org/10.52872/001c.29559
[24]Ying M, Wang S, Bai C, Li Y. Rural-urban differences in health outcomes, healthcare use, and expenditures among older adults under universal health insurance in China. . Plos One. 2020; 15: e0240194. https://doi.org/10.1371/journal.pone.0240194
[25]Baek Y, Iuliano S, Robbins J, Poon S, Seeman E, Ademi Z. Reducing hip and non-vertebral fractures in institutionalised older adults by restoring inadequate intakes of protein and calcium is cost-saving. Age Ageing. 2023; 52: afad114. https://doi:10.1093/ageing/afad114
[26]Yang Y, Wang G, Pan X. Chinese Food Composition Table. Peking University Medical Press: Beijing. 2004.
[27]Yang Y, Wang G, Pan X. Chinese Food Composition Table. Peking University Medical Press: Beijing. 2009.
[28]Institute of Medicine. Dietary Reference Intakes: Applications in Dietary Assessment. National Academies Press: Washington, DC. 2000. https://doi.org/10.17226/9956
[29]Chen R, Tang Y, Fang S, Gong K, Liu D, Xie Y, et al. Total, dietary, and supplemental calcium intake and risk of all-cause, cardiovascular, and cancer mortality among U.S. adults: A prospective cohort study from the National Health and Nutrition Examination Survey. Archives of Osteoporosis. 2024; 19: 114. https://doi.org/10.1007/s11657-024-01457-5
[30]Kim JH, Lee SB. Evaluation of Activities of Daily Living: Current Insights and Future Horizons. Annals of Geriatric Medicine and Research. 2025; 29: 143–158. https://doi.org/10.4235/agmr.24.0172
[31]Liang M, Yin M, Guo B, Pan Y, Zhong T, Wu J, et al. Validation of the Barthel Index in Chinese nursing home residents: An item response theory analysis. Frontiers in Psychology. 2024; 15: 1352878. https://doi.org/10.3389/fpsyg.2024.1352878
[32]Li R, Che B, Xiao W, Shu J, Ma X, Wang Y, et al. Association between multimorbidity patterns and activities of daily living function among older adults in China: A longitudinal population-based cohort study. BMC Geriatrics. 2025; 25: 885. https://doi.org/10.1186/s12877-025-06567-4
[33]He S, Bian Y. Older adults's hospitalizational costs and burden study in China--analysis from CHARLS data 2018. Front Public Health. 2024; 12: 1418179. https://doi.org/10.3389/fpubh.2024.1418179
[34]WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet (London, England). 2004; 363: 157–163. https://doi.org/10.1016/S0140-6736(03)15268-3
[35]Song Q, Smith JP. Hukou system, mechanisms, and health stratification across the life course in rural and urban China. Health & Place. 2019; 58: 102150. https://doi.org/10.1016/j.healthplace.2019.102150
[36]Zhao Z. Hukou and Urban-Rural Educational Inequality: Who Are Left Out? Lecture Notes in Education Psychology and Public Media. 2023; 2: 628–637. https://doi.org/10.54254/2753-7048/2/2022401.
[37]Deng Z, Law YW. Rural-to-urban migration, discrimination experience, and health in China: Evidence from propensity score analysis. PloS One. 2020; 15: e0244441. https://doi.org/10.1371/journal.pone.0244441
[38]Lyu S, Kang S, Koo J-H. Social Capital Inequality According to Hukou in Unequal Economic Environments in China. Sustainability 2022; 14: 13748. https://doi.org/10.3390/su142113748
[39]Wieditz J, Miller C, Scholand J, Nemeth M. A Brief introduction on latent variable based ordinal regression models with an application to survey data. Statistics in Medicine. 2024; 43: 5618–5634. https://doi.org/10.1002/sim.10208
[40]Angrist JD, Pischke J-S. Mostly harmless econometrics: An empiricist's companion. Princeton university press: New Jersey. 2009.
[41]Wooldridge JM. Econometric analysis of cross section and panel data. MIT press: Cambridge. 2010.
[42]Vanderweele TJ. Explanation in causal inference: Methods for mediation and interaction. Oxford University Press: New York, NY, US. 2015.
[43]Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology. 1986; 51: 1173–1182. https://doi.org/10.1037//0022-3514.51.6.1173
[44]MacKinnon DP, Fairchild AJ, Fritz MS. Mediation analysis. Annual Review of Psychology. 2007; 58: 593–614. https://doi.org/10.1146/annurev.psych.58.110405.085542
[45]Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Dietary Reference Intakes for Calcium and Vitamin D. 2011. https://doi.org/10.17226/13050
[46]Huang F, He Y, Su C, Zhang J, Du W, Jia X, et al. Macroelements Intake in Chinese Adults - 10 PLADs, China, 2022-2023. China CDC Weekly. 2025; 7: 1–5. https://doi.org/10.46234/ccdcw2025.001
[47]Wang J, Shu B, Tang DZ, Li CG, Xie XW, Jiang LJ, et al. The prevalence of osteoporosis in China, a community based cohort study of osteoporosis. Frontiers in Public Health. 2023; 11: 1084005. https://doi.org/10.3389/fpubh.2023.1084005
[48]Russell AJ, Hartman JJ, Hinken AC, Muci AR, Kawas R, Driscoll L, et al. Activation of fast skeletal muscle troponin as a potential therapeutic approach for treating neuromuscular diseases. . Nature Medicine. 2012; 18: 452–455. https://doi.org/10.1038/nm.2618
[49]Tan L, He R, Zheng X. Effect of vitamin D, calcium, or combined supplementation on fall prevention: a systematic review and updated network meta-analysis. BMC Geriatrics. 2024; 24: 390. https://doi.org/10.1186/s12877-024-05009-x
[50]Farshbaf-Khalili A, Malekmirzaei E, Babaie S, Pakpour V. The determinants of self-care behaviors and calcium-vitamin D intake in elderly women: A comparative study of osteoporosis and healthy counterparts. Scientific Reports. 2025; 15: 27290. https://doi.org/10.1038/s41598-025-12755-4
[51]Monsivais P, Aggarwal A, Drewnowski A. Are socio-economic disparities in diet quality explained by diet cost? Journal of Epidemiology and Community Health. 2012; 66: 530–535. https://doi.org/10.1136/jech.2010.122333
[52]Sayer AA, Cooper R, Arai H, Cawthon PM, Ntsama Essomba MJ, Fielding RA, et al. Sarcopenia. Nature Reviews. Disease Primers. 2024; 10: 68. https://doi.org/10.1038/s41572-024-00550-w
[53]White JV. Risk factors for poor nutritional status in older Americans. American Family Physician. 1991; 44: 2087–2097.
[54]Shapses SA, Heshka S, Heymsfield SB. Effect of calcium supplementation on weight and fat loss in women. The Journal of Clinical Endocrinology and Metabolism. 2004; 89: 632–637. https://doi.org/10.1210/jc.2002-021136
[55]Cormick G, Belizán JM. Calcium Intake and Health. Nutrients. 2019; 11: 1606. https://doi.org/10.3390/nu11071606
[56]Gong J, Li X, Shi L, Jing X, Liao X, Ma Y, et al. Chinese Expert Consensus on Home Nutrition Administration for Older Patients (2024). Journal of Evidence-based Medicine. 2025; 18: e70025. https://doi.org/10.1111/jebm.70025
[57]Wei J, Fan L, Zhang Y, Li S, Partridge J, Claytor L, et al. Association Between Malnutrition and Depression Among Community-Dwelling Older Chinese Adults. Asia-Pacific Journal of Public Health. 2018; 30: 107–117. https://doi.org/10.1177/1010539518760632
[58]Holick MF. Vitamin D deficiency. The New England Journal of Medicine. 2007; 357: 266–281. https://doi.org/10.1056/NEJMra070553
[59]Passeri G, Giannini S. Benefits of Vitamin D in Health and Diseases. Nutrients. 2023; 15: 2419. https://doi.org/10.3390/nu15112419
[60]Chen J, Yun C, He Y, Piao J, Yang L, Yang X. Vitamin D status among the elderly Chinese population: a cross-sectional analysis of the 2010-2013 China national nutrition and health survey (CNNHS). Nutrition Journal. 2017; 16: 3. https://doi.org/10.1186/s12937-016-0224-3
[61]Lu L, Yu Z, Pan A, Hu FB, Franco OH, Li H, et al. Plasma 25-hydroxyvitamin D concentration and metabolic syndrome among middle-aged and elderly Chinese individuals. Diabetes Care. 2009; 32: 1278–1283. https://doi.org/10.2337/dc09-0209
[62]Hu Y, Chen J, Wang R, Li M, Yun C, et al. Vitamin D Status and Associated Factors of Older Adults in the Cross-Sectional 2015–2017 Survey. Nutrients. 2023; 15: 4431. https://doi.org/10.3390/nu15204431
- Abstract
- Keywords
- 1. Introduction
- 2. Method
- 2.1 Study Population
- 2.2 Measurement of Calcium Intake Sufficiency
- 2.3 Assessment of Functional Ability and Healthcare Costs
- 2.4 Confounders
- 2.5 Statistics
- 3. Results
- 3.1 Basic Characteristics of Subjects by Calcium Intake Sufficiency
- 3.2 Association Between Calcium Intake Sufficiency and Functional Ability
- 3.3 Association Between Functional Ability and Healthcare Costs
- 3.4 Association Between Calcium Intake Sufficiency and Healthcare Costs
- 4. Discussion
- 5. Conclusion
- Availability of Data and Materials

